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THE COMMON COLICS 
me 2he HORSE 


Their Causes, Symptoms, Diagnosis, and 
Treatment 


BY 


eee ON REE KS, F.R-C.V.S. 


EXAMINER IN PATHOLOGY AND BACTERIOLOGY TO THE BOARD OF EXAMINERS 
OF THE ROYAL COLLEGE OF VETERINARY SURGEONS 


AUTHOR OF ‘DISEASES OF THE HORSE’S FOOT’ ° 


SECOND EDITION 


CHICAGO 
mom. GER 


IQI2 


as 
= 


614, | 
R2S¢ 
eee 


TO 


SIR JOHN M’FADYEAN 
(M.B., B.Sc., F.R.S.E.), 
Principal and Dean of the Royal Veterinary College, Londo, 


Tages Jetoncer, 19 904,/95-/. 


AS A MARK OF RESPECT 


i 


IBS ¢9 


Peereacer JO THE SECOND EDITION 


Six years have elapsed since this little work was first 
published, and the passage of time has rendered necessary 
a few alterations and additions. The task of penning 
these has been a pleasant one, for the fact that after the 
exhaustion of the first edition, and a second large reprint 
of it, a second edition should be called for is gratifying 
proof that the book has supplied a need and served some 
useful purpose. It now only remains for me to mention 
anything of importance concerning the reception of the 
first edition that would interest the reader of the second, 
and to record here the alterations that have been made. 
In the reception accorded the first, the most pleasing 
feature to me was the number of unsolicited letters it 
brought me from practitioners, both English and 
American, concerning what I have now come to call the 
‘stimulant’ treatment of intestinal impaction. Many 
who have, in the phrase of one of them, ‘ put thety sedatives 
on the shelf, have written in terms expressive of their 
delight with the change, and assuring me that, if I 
needed confirmation of the correctness of the treatment, 
their own experience would give it. Although pleasing 
to me, I merely mention this fact here in order that the 
reader, should he contemplate a change which at first 
sight may appear to him startling, may be assured that, 
concerning its wisdom, he has not to rely on my word 
Vil 


Vili PREFACE TO THE SECOND EDITION 


alone. He now has corroborative testimony. In this 
connection, seeing that it is more or less a summary 
of the arguments both for and against the stimulant 
treatment, I may point out that I have now included in 
the Appendix (Part II.) an article on *2hes@eecand 
Abuse of Sedatives in the Treatment of the Equine 
Coles: ; 

Regarding the other additions, perhaps the most 
important is that of Chapter X., on ‘Subacute Obstruc- 
tion of the Pelvic Flexure of the Colon.’ This, I hope, 
is a further step towards the clearer diagnosis of intes- 
tinal obstructions, and I trust the matter there recorded, 
together with the diagrams illustrating it, will lead others 
to a comprehension of these troubles even more exact 
still. 

To Chapter II., which deals with the surgical anatomy, 
I have added diagrams which may, perhaps, define more 
clearly than the words the formation of the so-called 
cardiac sphincter of the stomach. | 

Appended to Chapter VII., that on ‘ Gastric Tympany,’ 
there is a description and illustration of a new stomach- 
tube, which shows promise of being of use in the treatment 
of both gastric tympany and gastric engorgement. 

Of alterations, there is only one of importance. It 
deals with a change of opinion, which I should be dis- 
honest in withholding, and will be found fully set out in 
Part III. of the Appendix. 

In conclusion, I again commend this book to the 
veterinary practitioner, asking him, above all, to make it 
but an aid towards the achievement of an end we must 
all of us have in view—the further elucidation of the 
troublesome affections with which it deals. 

HHG,: Re 


SPALDING, 
January, 1909. 


Peon [QO THE FIRST EDITION 


A.t the commencement of a volume, be it small or large, 
it is usual to make a few prefatory remarks. The cus- 
tom is a wise one, for it enables the author to state the 
various conditions and circumstances that brought the 
book into being, to put forth clearly the object and 
general scope of the work, and to apologize, where need 
be, for the imperfections it contains. Lastly, it affords 
an opportunity to inform the reader of the sources whence 
the material for the work was obtained. 

The conditions and circumstances that brought this 
little volume into existence are few but important. 
The practice into which I settled soon after qualifying 
was one in which cases of so-called ‘ colic’ bulked very 
largely. Their extreme importance to the stock-owner, 
the large measure of anxiety and responsibility they give 
the veterinarian, and the short time the horse will suffer 
before succumbing, are all circumstances that render 
their accurate diagnosis and treatment a matter of the 
utmost urgency. 

The gravity of the cases, and the urgency with which 
they impressed me, compelled me to look round in our 
literature for more than the ordinary text-book treatment. 
This I was unable to find, except by careful and 
wearisome plodding through masses of journals and 

1X 


4 PREFACE TO THE FIRST EDITION 


periodicals. Reported matter I found in abundance, but 
it required to be drawn up and put into a convenient 
space for easy digestion. 

What I so pressingly needed myself, I judged others 
would need also. Consequently, though the work might 
well have been left to far abler hands than my own, I 
resolved to record the result of my readings and investi- 
gations, tempered with what experience I possessed my- 
self, in the form this little book presents. | 

My first intentions as to the scope of this work were 
ambitious, and I commenced it under the title of ‘ The 
Equine Colics.’ This I found was far too embracing, 
for it would have led me into a consideration and de- 
scription of ailments that have been ably dealt with 
elsewhere—e.g., the colic of hernia, the re due to 
parasites, etc. | 

Finally, the title that now heads the book was selected, 
It will limit me to a consideration of those disorders with 
which I feel myself competent to deal. 

Regarding the imperfections the book contains, they 
can be apparent to no one more than the author. The 
very failings of a work, however, will often set going a 
wheel of discussion and thought that no amount of fore- 
si¢ht could otherwise iniviate. That being so, I am 
content to leave it. 

Lastly, I am to confess the source whence I ethed 
my materials. That duty is easy. I have not scrupled 
to avail myself to the uttermost of anything I have 
heard or read. The man who sits himself down to write 
an original work, unless it be one of fiction, is handi- 
capped at the very outset. The knowledge he is already 
possessed of he largely owes to former brains and other 
people’s experiences. In medicine he is bound to pro- 
visionally accept what greater minds than his own have 


PREFACE TO THE FIRST EDITION xl 


been for generations establishing. If by one iota he 
' can add to the knowledge already accumulated, he is a 
lucky man. 

My plagiarism confessed, I feel no need to publish a 
list of the literature to which I am indebted. I would, 
however, particularly like to mention two names: The 
first, that of William Percivall, whose writings have 
fallen into an obscurity they certainly do not deserve; — 
the second, Veterinary-Colonel Fred Smith, from whose 
works I have very largely drawn, and whose contribu- 
tions to this and allied subjects have been such as to 
place the veterinary profession under a deep debt of 
gratitude, 

I would also mention that the courtesy of Sir John 
M’Fadyean enables me to reprint from the Journal of 
Comparative Pathology and Therapeutics an article of my 
own that now forms the subject-matter of Chapter IX. 
Professor Macqueen has kindly allowed me to make 
use of his valuable experiments concerning the opera- 
tion of laparo-enterotomy, and Mr. E. R. Harding, of 
Salisbury, has furnished me with his experiences relating 
to the stimulant treatment of intestinal impaction. 

Ihe attempt in Chapters IX., X., and XI.! to dif- 
ferentiate varieties of subacute intestinal obstruction 
may be regarded as the main original portion of this 
work, fF or the present, I simply ask for that a careful 
reading. 

This book, then, carries no pretence to being entirely 
original. It is a gathering together of observations that 
other minds have made, with just so much of my own 
experience as would enable me to weld the loose particles 
into one presentable whole. I am not without hopes 


1 In this, the second edition, these are now Chapters IX., XI., 
and XII,—H. C. R. 


xii PREFACE TO THE:-FIRST EDiTiee 


that the manual will prove of help to the student, and 
enable him to progress still farther on the road of inde- 
pendent thought, upon the commencement of which his 
present-day tutors so ably plant his feet. 

To the practitioner I humbly trust this first effort of 
my pen will prove welcome. I ask him for his in- 
dulgence, and beg of him to remember that these pages 
were written in the moments of leisure afforded by a busy 
country practice. Should it be the means of bringing 
together such facts as will give the veterinarian a more 
accurate and dependable knowledge of the subjects under 
consideration, the main object of the book will be 
fulfilled. 

HH, Goa: 


SPALDING, 
October, 1902. 


CHAPTER 


I. 
oH, 
III. 
IV. 
¥. 
VI. 


VIII. 


XIII. 


XIV, 


CONLENTS 


‘COLIC,’ ITS DEFINITION > . ° 
SURGICAL ANATOMY OF THE ABDOMEN ° 
HOW TO EXAMINE THE PATIENT : - 


ETIOLOGY : GENERAL PREDISPOSING CAUSES 
ETIOLOGY : GENERAL EXCITING CAUSES : 
GASTRIC IMPACTION (GORGED STOMACH, GRASS 

STAGGERS, OR STOMACH STAGGERS) . 
GASTRIC TYMPANY (GASTRECTASIS, OR DILATA- 

TION OF THE STOMACH) - - - 
RUPTURE OF THE STOMACH (GASTRORRHEXIS) 


peo eal LTE OBSTRUCTION OF THE DOUBLE COLON 


(IMPACTION OF THE INTESTINES, IMPACTION 
OF THE COLON, STOPPAGE OF THE BOWELS) 
SUBACUTE OBSTRUCTION OF THE PELVIC 
FLEXURE OF THE DOUBLE COLON - - 
SUBACUTE OBSTRUCTION OF THE SINGLE COLON 
SUBACUTE OBSTRUCTION OF THE SMALL INTES- 
TINES - - - - - 
INTESTINAL IRRIGATION IN OBSTRUCTIONS OF 


THE COLON - - - ° os 
THE SURGICAL TREATMENT OF INTESTINAL 
OBSTRUCTIONS - > - ° 


xl 


PAGE 


XiV CONTENTS 


CHAPTER 
XV. INTESTINAL TYMPANY (WIND COLIC, FLATULENT 


COLIC, HOVEN, TYMPANITES, ETC.) - ‘ 
XVI. ENTERITIS (INFLAMMATION OF THE BOWELS) - 
XVII. SUPERPURGATION - n ‘ 2 
XVIII. THE TREATMENT OF COLIC IN YOUNG, UN- 
BROKEN ANIMALS - - « i 


APPENDIX: 
I. THE COMPOSITION OF VARIOUS FOODS: 
DIGESTIVE COEFFICIENTS OF FOODS * 
JI. THE USE AND ABUSE OF SEDATIVES IN 
THE TREATMENT OF THE EQUINE COLICS 
III. FURTHER REMARKS ON THE USE OF ALOES 


IN THE TREATMENT OF INTESTINAL 


IMPACTIONS hes = - - 


PAGE 


189 
200 
212 


219 


228 


235 


251 


CMW AUN 


10. 


II. 


12. 


iz: 


14. 
15. 


meee Or ILLUSTRATIONS 


SURGICAL REGIONS OF THE ABDOMEN - - 


. LONGITUDINAL SECTION OF STOMACH AND PYLORUS 
- PHOTOGRAPH OF STOMACH TO ILLUSTRATE FIG. 2 
. SUPERFICIAL OR EXTERNAL MUSCULAR COAT OF 


STOMACH . . - E A 
MIDDLE MUSCULAR COAT OF STOMACH - - 
INTERNAL OR DEEP MUSCULAR COAT OF STOMACH 
KNISELY’S STOMACH-TUBE - : 2 
THE NORMAL DOUBLE COLON”S - = : 


VOLVULUS OF THE PELVIC FLEXURE OF THE 


DOUBLE COLON - - . - 
THE SAME, WITH THE COLON PULLED OUT FROM 
THE ABDOMEN AND EXTENDED - - 
IMPACTED PORTION OF SMALL COLON SUSPENDED 
BY MESENTERY - . - : 
SEAT OF LAPARO-ENTEROTOMY (MACQUEEN’S 
OPERATION) - : - - : 
OPERATION WOUND (LAPARO-ENTEROTOMY) . 
LEMBERT'S SUTURES (IN SMALL COLON) - - 
CALCULUS OBSTRUCTING SMALL COLON (MR. 
HARDING'S CASE) - : - - 


xV 


124 
126 
127 


168 


177 
178 
180 


187 


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Peo VNMON COLICS OF 
mere HORSE. 


OMAP LTER ft 
‘COLIC,’ ITS DEFINITION 


NING a disorder that has been recognised and 
for years beyond the memory of man, one would 
e that its name, and what that name conveyed, 
be well known and understood. Such, however, 
he case. | 
word ‘colic’ is derived from the Latin colicus or 
ek kolikos, signifying the colon, and, strictly em- 
means a painful, spasmodic affection of the 
es, especially of the colon. Far from retaining 
simple signification, colic, in the horse, has for a 
e served to designate innumerable and widely 
g diseases, whose only point in common has been 
idence of abdominal pain, The term must 
rily be most vague when it attempts to offer any 
tion of a particular case in which the symptoms 
t largely those of pain in the abdomen. If we 
word in its most restricted sense, it should mean 


- 
a 


2 THE COMMON COLICS OF THE HORSE 


only pain in the bowels, or enteralgia. This is an 
abnormal sensibility in the region of the plexus mesen- 
tericus, and, as such, is not often observed in our patients. 
In the widest possible acceptation of the term, colic will 
indicate—apart from this enteralgia—all painful affections 
of the intestines which are not consequent upon inflam- 
mation or textural change of the bowel walls. 

It is quite plain that our first duty should be to 
tabulate, as far as possible, the different morbid condi-— 
tions that may give rise to colic—using the word in its 


widest sense. This has already been done by that — 
eminent and conscientious clinical observer, Professor — 


Friedberger, of Munich. In his pamphlet, ‘ Die Kolik 
der Pferde, Sechs Klinische Vortrage,’ he gives this table: 


1. True Colic, proceeding from the intestinal canal, 
and stomach.+ 

2. False Colic, arising from a diseased state of the 
other abdominal organs. (Under this heading will come ~ 
especially affections of the bladder and sexual organs,- 
which give rise, in the first instance, to similar external 
evidences of suffering.) 


True Colic is then taken and subdivided in the follow- 
ing manner : 


1 The addition of the words ‘and stomach’ is my own. Much — 


though I dislike to interfere with the arrangement tabulated by — vn 1 


Professor Friedberger, I cannot help but think that stomach 
troubles should be included under the heading of True Colic. — 
Following the strict letter of all accepted definitions, I know it 


should be omitted. Nevertheless, the close manner in which many 


of the symptoms proceeding from the stomach simulate those 
arising from the intestinal canal, with the fact that anomalies of the 
former tend to the production of disorders of the latter, points 
conclusively to the necessity of carefully considering stomach 
ailments when treating of those of the intestines.—H. C, R, 


“COLIC,” ITS. DEFINITION 3 


A. Essential, to which may be referred the under- 
mentioned causes : 

1. Colic without material cause, as the so-called 
nervous cramp (or rheumatic colic). - 

2. Colic consequent upon anomalies of the intestinal 
contents. Such are: 

(a) Colic produced by overfeeding. 
(b) Colic brought on by flatulence (wind colic). 
(c) The colic occasioned by stoppages in the 
intestinal canal. These obstructions 
may arise from fecal accumulations, 
stones, concretions, etc, 
B. Symptomatic. Such are: 

1. The colic produced by worms. 

2. The colic resulting from poisons, 

3. Colic brought on by structural disease and 
changes in the relative position of the 
intestines; colic occasioned by acute catarrh 
-and croup affecting the delicate mucous 
membrane of the colon; colic from carbun- 
cular formations on the mucous membrane ; 
colic from dysentery, and from_ so-called 
internal cramp; colic from wounds of the 
stomach and entrails, and colic from spon- 
taneous laceration or perforation of those 
organs. 

4. Colic resulting from morbid conditions of the 
abdomen and the covering of the intestines 
(peritoneum). 


A mere perusal of this extensive and complete classi- 
fication of the varieties of colic will serve to impress upon 
us the absolute necessity of looking for much more than 
the mere exhibition of pain on the part of our patient in 

| I—2 


4 THE COMMON COLICS OF THE HORSE 


order to arrive ata diagnosis that will approach with any 
degree of accuracy to the truth. 

- The human surgeon, by clear and incisive reasoning 
deduced from the symptoms observed by himself and the 
help afforded him by his patient, has the power of making 
such subtle distinctions in the different varieties of colic 
as to render his skill in diagnosis an object of admiration 
to the veterinarian. 

One word of warning is necessary to the animal surgeon. 
His admiration of the human physician’s diagnosis must 
not lead him to follow blindly those symptoms and treat- 
ments laid out in medical literature. 

I am well aware that in very many diseases there is 
an extremely close analogy between the veterinary and 
human patient, both in regard to the symptoms and the 
treatment. That, however, is uot the case with colic. 

The ordinary text-book on human medicine seldom 
devotes more than a few pages to its consideration. Its 
treatment, unless it be the colic due to hernia or other 
equally serious cause, is comparatively simple, and 
occasions the physician no alarm. He administers an 
opiate, and, where occasion demands, combines the 
sedative with a brisk purgative. 

That done, the case is comfortably dismissed from his 
mind. He is not unduly anxious about pains whose 
continuance is pie over three or four days—nay, even 
weeks. 

Compare that with the ceele to forty-eight or sixty 


hours of anxious watching that so often falls to the lot of — 


the veterinarian—a two days’ hurried, anxious solicitude 
into which is crammed the diagnosis and treatment of 
three weeks. To illustrate my point, compare the cases 
of intestinal obstruction in the horse and the human 
patient. 


‘COLIC,’ ITS DEFINITION 5 


Owing to circumstances which I shall endeavour to 
explain in a future chapter, one day’s illness in the horse 
is practically of the same length as a week’s suffering 
from the same ailment inman. The veterinarian is com- 
pelled to crowd into one day a diagnosis and treatment 
that the human medico may methodically and easily 
atrive at by a week’s careful study of the symptomatology 
and history furnished by his patient. 

This apparent digression is really a lengthening of the 
definition ; it is inserted for this reason. I desire to 
indicate as forcibly as lies within me one fact—human 
and equine colic in no material way bear likeness one 
to the other. My excuse for trespassing so far into the 
ae nain of human medicine in connection with this point 
_ is this: I have so frequently seen veterinarians attempt- 
ing to base their treatment on knowledge derived from 
_ medical literature referring to man. I feel sure that 
nothing could lead them further from the truth. 
Colic,’ so long as the horse exists, will always have a 
o terrible significance for the practitioner of veterinary 
‘medicine. It still continues, in many of its aspects, to 
baffle the most careful and painstaking observer. It still 
claims annually many thousands of victims. Anthrax, 
tuberculosis, and other dire disorders still persist in 
carrying off their spoils, but it is doubtful to my 
‘mind whether any other ailment in the whole cate- 
gory of veterinary diseases is accountable for more loss, 
_ more anxiety, and more self-scourging than is ‘ colic.’ 


CHAPTER II 
SURGICAL ANATOMY OF THE ABDOMEN 


A THOROUGH knowledge of the regional anatomy of the 
abdomen is absolutely essential to the determination of a 
definite diagnosis. ‘The man who has strongly insisted 
upon that, and devoted an enormous amount of time 
and thought to the subject, is Lieutenant-General Fred 
Smith. It is the result of his work that forms the 
subject-matter of the present chapter, and I take this 
opportunity of thanking him for his kindness in allowing 
me to incorporate it with this volume. In his letter 
granting me permission to use it he says: ‘The infor- 
mation in these few pages represents an immense amount 
of work. I do not remember, now, how many dissections 
I made in the upright position, but a large number.’ 
* x x * ** 

For surgical purposes the abdomen is best divided 
into a superior and inferior zone by a line drawn horizon- 
tally from the hip-joint to the ribs. These zones are 
further subdivided into three parts by means of two 
vertical lines carried round the abdomen, one from the 
body of the first lumbar vertebra, and the other passing 
just in front of the antero-inferior spinous process of the 
ilium. By these means we have the abdomen mapped 
out into a superior and inferior zone, and each zone into 

6 


SURGICAL ANATOMY OF THE ABDOMEN ” 


_an anterior, middle, and posterior region ; but in order to 
prevent confusion we will number these regions —thus, 
the anterior, middle, and posterior regions of the superior 
zone will be 1, 2, 3, whilst the same regions of the 
inferior zone will be 4, 5, 6 (see Fig. 1). Regions 1, 2, 
and 3 would be respectively the superior diaphragmatic, 
lumbar, and pelvic regions, whilst 4, 5, and 6 would be 
the inferior diaphragmatic, lumbar, and pelvic regions. 
The largest region is the inferior, and the smallest the 


reerm- 


fad Bi 


Fic. 1.—SURGICAL REGIONS OF THE ABDOMEN, 


1, Superior diaphragmatic ; 2, superior lumbar; 3, superior pelvic ; 
4, inferior diaphragmatic; 5, inferior lumbar ; 6, inferior pelvic. 


superior diaphragmatic. We shall find these landmarks 
of great use to us in studying the relation of the viscera 
to its walls. 

The cavity of the abdomen is nearly ovoid; its long 
axis is directed obliquely from above downwards and 
forwards; it is bounded anteriorly by the diaphragm, 
posteriorly by the pelvis, laterally and inferiorly by its 
walls, and superiorly by the lumbar portion of the spine. 
In order to thoroughly comprehend the arrangement 
of the abdominal viscera, it is absolutely necessary to 
bear in mind the direction of this cavity and that of the 
diaphragm. 


8 THE COMMON COLICS OF THE HORSE 


The Peritoneum.—The parietal layer is very loosely 
attached to the abdominal walls, which fact constitutes 
an important practical point in connection with opera- 
tions performed in its vicinity. The parietal portion 
occasionally forms part of a hernial sac, but not always, 
as owing to its slight elasticity it more often ruptures. 
The posterior surface of the bladder and a portion of the 
rectum and vagina are all uncovered by peritoneum— 
points to be-remembered in connection with the surgery 
of these parts. 

The Stomach presents several details of great sur- 
gical importance: its small size, the presence of an 
arrangement usually preventing vomition, its position in 
the abdomen, and its shape, are all points of great interest 
to us, and have a direct bearing on many of the diseases 
affecting it. It is situated in the left hypochondrium, 
but under distension extends into the epigastric and 
right hypochondriac regions, The organ is suspended 
from left to right (cardia to pylorus), obliquely down- 
wards, with the lesser curvature looking towards the 
right side; the stomach is situated principally to the 
left of the spine, in apposition with the diaphragm, and 
extends from near the last ribs on the left side to the 
upper surface of the colon on the right half of the body. 
To the right it is in contact with the liver, the left 
extremity being in apposition with the spleen, diaphragm, 
left kidney, and left prerenal capsule, whilst inferiorly it 
rests on the double colon at the sternal curve, which 
prevents the stomach, no matter what its state of dis- 
tension may be, from ever being in actual contact with the 
abdominal walls. ‘The cesophagus enters the stomach at 
the lesser curvature, and, owing to the peculiarity of its 
arrangement, prevents, under ordinary circumstances, 
anything from passing through it in the reverse direction. 


SURGICAL ANATOMY OF THE ABDOMEN 9 


The cardiac extremity of the cesophagus is very thick, 
the opening into the stomach small and filled with the 
folds of mucous membrane lining it, and the cardia 
itself surrounded by muscular fasciculi producing a 
powerful occlusion of the orifice. It is owing to these 
- causes that the horse is usually unable to vomit. 

From careful dissection I have found the following 
to be the arrangement of the cardiac fibres: Around the 
cardia and left extremity of the stomach are three layers 
of muscular fibres—(1) the external, running towards the 
pylorus and also over the left cul-de-sac ; (2) the middle, 
running round the cardia, being a continuation of the 
circular fibres of the cesophagus, and very thick at the 
portion situated im the lesser curvature ; (3) the internal, 
running in the direction of the long axis of the organ, 
passing as a loop round the left side of the cardia, 
but leaving the nght side, ov that portion situated within the 
lessey curvature, without fibves. It is this layer, in conjunc- 
tion with the middle layer, which forms the so-called 
sphincter, for, owing to the arrangement of the fibres, 
the cardia is compressed on the left towards the right by 
the (looped fibres of the)! internal layer, and on the 
right towards the left by the middle layer. The pyloric 
extremity of the stomach is supplied with a sphincter, 
the so-called pyloric ring. 

We believe that, in addition to the resistance offered 
to vomition by the cardia, the contraction of the 
cesophagus (at least, the posterior half of it) materially 
assists in preventing anything passing along it in the 
reverse direction, for we always find that where dilatation 
of the cardia has occurred so as to allow vomition the 
cesophagus is likewise dilated and its walls are flaccid. 

On examining a stomach and cesophagus after death, 


1 The insertion in brackets is mine.—H. C. R. 


10 THE COMMON COLICS OF THE HORSE 


in a case where vomiting has occurred during life, we 
find the parts flaccid and easily dilatable; the fingers 
may be introduced with freedom into the cardia, the 
lining membrane of the cesophagus is no longer in 
apposition, and on dividing the gullet for the purpose of 
removing the stomach, no matter how far forward it 
is cut, the fluid contents of the viscus (that is, if this 
organ be entire) will pour out. In a case of epilepsy 
which occurred in my practice, I found after death, 
although there had been no vomiting during life, the 


Fic. 2.—LoONGITUDINAL SECTION OF STOMACH AND PYLORUS. 


a, Opening of cardia; b, pylorus ; c, commencement of 
duodenum ; 4, pyloric or duodenal ‘ trap.’ 


cardia and cesophagus in this condition. The cardiac 
and pyloric orifice of the stomach are not far apart; the 
pyloric is below the cardiac. A very singular and 
important arrangement of the pylorus and duodenum 
exists; dissection reveals that the duodenum, where it 
commences at the pylorus, is S-shaped and much dilated, 
forming an arrangement not at all unlike an §-trap used 
in drain-pipes (see Figs. 2 and 3). This direction of the 
duodenum appears to regulate the pace at which the 
ingesta should pass through; as soon as the trap is 
formed, the duodenum ascends towards the spine lying 


SURGICAL ANATOMY OF THE ABDOMEN II 


all the while on the colon. It is easy to see how simple 
it is for a distended stomach and intestines to press upon 
the pyloric trap, and practically occlude it; this is the 
second factor in producing ruptured stomach. 

The Small Intestines are divided by the anatomists 


Fic. 3.—PHOTOGRAPH OF STOMACH TO ILLUSTRATE Fic. 2.} 


a, Esophagus ; b, pylorus; c, commencement of duodenum ; 
| da, pyloric or duodenal ‘ trap.’ 


of the present day into two portions, the fixed or duodenal 
and fre: or floating; they are about 70 feet in length. 
The duodenal portion commences from the pylorus, 
passes under the concave surface of the liver in a direc- 
tion upwards and outwards, lying on the double colon 


1 I have inserted this photograph to illustrate General Smith’s 
diagram. The stomach was removed from the abdomen, and the 
duodenal §-trap carefully arranged as it lies im situ.—H. C. R. 


12 THE COMMON COLICS OF THE HORSE | 


and passing in apposition with the last rib, where it may 
readily be found at the lower part of its upper third, just 
where the extremity of the transverse processes of the 
first lumbar vertebra reaches ; it then passes immediately 
behind the right kidney opposite to the second lumbar 
vertebra, crossing the spine transversely behind the 
anterior mesenteric artery; it is then attached to the colon, 
and terminates in becoming continued by the floating 
portion in the left flank. Where the duodenum rests on 
the colon and passes under the last ribs on the right side 
is a practical point of considerable importance. 

The free portion of the small intestines is suspended 
by means of the mesentery from the underneath portion 
of the spine ina spiral form ; owing to the length of the 
mesentery and this mode of attachment, volvulus of the 
bowels is, unfortunately, only too common. ‘The small 
intestines hang well in the centre of the body, and lie in 
the curve formed by the double colon; they terminate at 
the czecum, crossing to the right side for this purpose, 
and opening into the gut close to the colon, but below it. 
This part is situated beneath the third lumbar vertebra, 
about 6 inches from its under surface. 

The Large Intestines are represented by the cecum, 
colon, and rectum ; they occupy a fairly regular position, 
and a knowledge of their disposition and course is im- 
perative. The ca@cum, or ‘blind gut,’ contains, on an 
average, about 8 gallons of fluid, and is over 3 feet 
in length. It usually occupies a position obliquely from 
above downwards and forwards, and presents superiorly 
a base, and inferiorly an apex. ‘The superior extremity, 
base, or arch, or, as well designated by Chauveau, 
‘crook,’ is situated in the right lumbar region close 
under the spine; it is in relation with the right kidney, 
duodenum, psoas muscles, colon, small intestines, and 


SURGICAL ANATOMY OF THE ABDOMEN 13 


pincreas. The crook or arch looks forwards, and in 
the concavity of the curve on its inside the small in- 
testine opens and the colon begins. The inferior ex- 
tremity is placed within the double colon at its sternal 
curve, the apex resting on the ensiform cartilage of the 
sternum ; at least, this is its usual position. The colon is 
divided into two portions, the single and double; it is 
about 12 feet in length. For convenience of description 
the double colon is divided into four parts; commencing 
from the crook of the cecum it proceeds forwards and 
downwards, passing beneath the right kidney (having the 
pancreas between it and that organ) to the diaphragm, 
and, bending to the left, forms its suprasternal flexure ; the 
second portion is continued from here, running backwards 
and upwards into the left flank, turning inwards opposite 
the pelvis and close up against the spine to form the pelvic 
fexuve ; now follows the third portion, running forwards 
above the second and attached to it by peritoneum: when 
it reaches the diaphragm it makes a curve to the right, 
the diaphragmatic flexure, followed by the fourth portion, 
which is attached by peritoneum to the first, and reaches 
posteriorly to the base of the caecum, where it terminates 
in the sémgle colon. ‘This crosses to the left side beneath 
the first lumbar and last dorsal vertebra, being attached 
by peritoneum to the crura of the diaphragm and the 
mesenteric vessels. The double colon at its origin is 
very small, but it quickly enlarges, and at the supra- 
sternal flexure is of considerable size; at its pelvic curve 
it is greatly reduced in volume, but at the diaphragmatic 
flexure it again enlarges, and close to where it terminates 
in the sigle colon attains its largest size, and then suddenly 
contracts to form the single colon. ‘These differences in 
the volume of the colon are of direct practical interest. 
The pelvic curvature and the single colon are the most 


14 THE COMMON COLICS OF THE HORSE 


frequent seats of obstruction from calculi, gravel, etc. 
which have passed with ease along the more dilated 
portion of the canal. 

The Single Colon lies in the left flank, is suspended 
from the spine by peritoneum, and extends to the pelvis, 
where it becomes continuous with the rectum. 

The Liver is situated principally in the right hypo- 
chondriac region, and is placed obliquely from above 
downwards from right to left. Its anterior face is applied 
against the diaphragm, its posterior against the stomach 
and intestines. The upper extremity of the right lobe is 
in apposition with the right kidney at the space between 
the sixteenth and seventeenth ribs; from here the liver 
extends downwards, inwards, and forwards, having 
between it and the costal walls the posterior lobe of the 
right lung and the diaphragm, and passing across the 
abdomen its middle lobe rests on the sternum. The 
right lobe extends as far forwards as about opposite the 
eleventh rib, as far back as the sixteenth or seventeenth, 
and reaches as low down as the inferior part of the middle 
third of the ribs. It is important to remember that, 
excepting at one small part (between the sixteenth and 
seventeenth ribs), the right lung and diaphragm are 
always between us and that organ, an anatomical fact 
which renders percussion almost useless in liver disease. 

The Spleen is situated on the left side of the abdomen ; 
it is attached superiorly to the left kidney and prerenal 
capsule, and anteriorly by peritoneum to the greater 
curvature of the stomach. The base of the organ extends 
to two or three inches behind the middle third of the last 
rib on the left side. 

The Pancreas is situated on the double colon, to the 
right side of the spine. At its upper part it is beneath 
the right kidney and close against the vena cava. Its 


SURGICAL ANATOMY OF THE ABDOMEN {5 


anterior border is in contact with duodenum and the 
the lesser curvature of the stomach. 

The Kidneys.—The vight has its anterior border 
reaching as far forward as the sixteenth rib, where it is 
in apposition with the liver; its posterior extends back 
to the first lumbar vertebra, its inferior edge as low as 
the middle third of the last rib but one. To the posterior 
part of this gland the base of the cecum is attached. 
The renal artery penetrates the organ immediately under 
the last rib. The Jeft kidney has its anterior border 
reaching only as far forward as the last rib, its posterior 
to the transverse process of the third lumbar vertebra. It 
lies up much closer to the spine than its fellow on the 
opposite side. 

A knowledge of the situation and position of the various 
abdominal organs is essentially necessary to the surgeon, 
for he may at any time be called upon to perform opera- 
tions in their vicinity. Take, for example, the simple 
one of ‘ puncturing the bowels,’ in performing which, by 
entering the trocar too high up on the right side, the 
duodenum or right kidney may be wounded, or the left 
side of the spleen or the left kidney. Such serious com- 
plications, liable to arise out of even a simple operation, 
can only be averted by a clear and certain acquaintance 
with the anatomy of the viscera. It is par cularly 
important to know the position they occupy in the living 
body ; having to this end arbitrarily divided the abdomen 
into the various regions before noticed, we will conclude 
this chapter by stating, in tabular form, the contents of 
each. 


R1iGHT SIDE OF ABDOMEN, 


Region No. 1, or superior 


prerenal capsule, and _ supero- 
diaphragmatic, 


posterior part of right lobe of 


Le border of right kidney, 
liver. 


16 


THE COMMON COLICS OF THE HORSE 


RIGHT SIDE OF ABDOMEN 


(continued) 


Resion *No0, <2, .or 
pelvic. 


Region No. 3, or 
pelvic. 

Region No. 4, or 
diaphragmatic. 
Region No.* 5;. OF 

lumbar. 
Region No. 6, or 
pelvic. 


Posterior part of right kidney, the 
base of the cz#ecum, termination 
of the ileum, commencement of 

< the double colon, part of the 

| duodenum, and, in the female, 


superior 


the right ovary, and upper part 
of right horn of uterus, 


The base of the cecum when dis- 
tended. 


The first and fourth portions of 
the double colon, part of the 
suprasternal and diaphragmatic 
flexures, the right and middle 
lobes of the liver, the inferior 
half of the caecum, the pancreas, 
portion of duodenum, and right 
extremity of stomach. 


superior 
inferior 


inferior \ Termination of the double colon. 


Portion of double colon, 
cecum when distended. 


inferior and 


LEFT SIDE OF ABDOMEN. 


Region No. 1, or superior fPortion of left extremity of 
diaphragmatic. stomach, 

Left kidney and prerenal capsule, 

Region No. 2, or superior base of the spleen, left ovary and 

lumbar. horn of uterus in female, third 


Region No, 3, 


pelvic. 

Region No. 4, or 
diaphragmatic, 
Region No. 5, or 

lumbar. 
Region No. 6, or 


pelvic, 


or superior 


portion of double colon. 


The pelvic flexure of the double 
colon. 


The second and third portions of 
double colon, the suprasternal 
and diaphragmatic flexures, the 
greater curvature of the stomach, 
portion of spleen and left lobe of 
the liver. 


Second and third portion of double 
colon, and coils of small. in- 
testines, part of the single colon, 
commencement of the rectum, 
and large part of the spleen. 


Pelvic flexure of the double colon, 
and coils of small intestines. 


inferior 


inferior 


inferior 


SURGICAL ANATOMY OF THE ABDOMEN 1? 


Following this summary of the regional anatomy as 
written by General Smith, I wish here to refer again to 
the arrangement of the cardiac fibres of the stomach. 
Their arrangement is so striking, and of such peculiar 
interest when we come later to discuss gastric tympany, 
that I wish, if possible, to render even more clear the 
excellent description of them he has given us, To that 


ry 
ip) 


) 
eet 


Fic. 4. SUPERFICIAL OR EXTERNAL MUSCULAR COAT OF STOMACH. 


A, esophagus; B, left sac ; C, right sac ; D, duodenal S-trap. 


end I append diagrams to illustrate them, and, although 
the matter arrived at is essentially the same as that set 
out on p. g, dissections I have made of the stomachal 
coats lead me to put their description into somewhat 
different words. They run as follows: 

1. A Superficial Plane.—This is evidently a con- 
tinuation of the longitudinal muscular layer of the 
cesophagus (see Fig. 4). It radiates obliquely over the 

2 


18 THE COMMON COLICS OF THE HORSE 


left sac, which it completely covers, leaving the right sac 
(indicated by the dotted lines) uncovered. In the lesser 
curvature its fibres become somewhat abruptly lost, while 
the greater curvature retains them to the entire envelop- 
ment of the underneath surface of the right sac, on 
whose upper surface they become gradually obliterated. 


. _— 


—— = 


ee 
Sans 4 J 
SS Yj 4, Ly jf fy) 


Y) 
—— Ae # 
at LZ Ye y 
eZ Vj ooo. Z 
Pate Z ‘ij . Lf Y 
NS . hi ae 
=" bh GeB a —2 7S, 


Fic. 5.—Mippre MuscuLar Coat oF STOMACH. 


a, Circular fibres (in one position lined more blackly than their 
neighbours), There is no aggregation of these fibres.} 
A, CEsophagus ; B, left sac; C, right sac; D, duodenal S-trap. 


2. A Middle Plane.—The fibres of this are again 
a continuation of the muscular coverings of the cesophagus 
—viz., of its circular coat (see Fig. 5). Running beneath 
- the fibres of the superficial plane, the middle coat also 
envelops the whole of the left sac. Where the fibres of 
the superficial plane become indistinct in the position of 


' This darker lining is for purposes of emphasis only.—H. C. R. 


: 
: 


SURGICAL ANATOMY OF THE ABDOMEN 19 


the lesser curvature and the pyloric end of the right sac 
they appear on the surface, and are there plainly visible 
—that is, at the point immediately indicated by the line a. 

3. A Deep Plane.—Like to the superficial, these 
fibres run somewhat obliquely in the direction of the 


long axis of the organ, wholly covering the left sac, and 


leaving the right sac free. 


\., 
z3 iy 
Ue "e 
eas. 
, ‘ 
A ’ 
ie. y SOD | 
oh ee 
t $ Hs 
- 
%, 
ra .e 
B 
‘Se a im 


Fic. 6.—INTERNAL OR DEEP MUSCULAR COAT OF STOMACH. 


a, A peculiar aggregation of the fibres, clasping the cardiac end 
of the cesophagus in the manner that a cravat does the 
neck. A, C£sophagus; B, left sac; C, right sac; D, duodenal 
S-trap. 


As I have indicated in the diagram (Fig. 6), at the 
point lettered a there is a distinct ridge-like aggregation 
of the fibres of this coat. These closely embrace the end 
of the cesophagus in the manner that a cravat does the 


neck. ‘Their point of greatest aggregation is,the left side 


a> a 


20 THE COMMON COLICS OF THE HORSE 


of the cesophagus. On the rightside of that canal (the 
portion situated within the lesser curvature) these fibres 
are wholly wanting. 

A brief consideration of the general arrangement of 
these fibres of the stomach of the horse will be sufficient 
to point out that the so-called cardiac sphincter is no 
myth. Taking the two opposite sets of fibres, those 
intentionally darkly lined at a, Fig. 5, and those of the 
cravat-shaped formation at a, Fig. 6, we see at once that, 
when contraction of the muscular coats of the stomach 
occurs, the lower end of the cesophagus, just where it 
enters the stomach, is bound to be gripped. While it is 
compressed from left to right by the fibres of the deep 
coat, it is at the same time compressed from right to left 
by the fibres of the middle coat. 

The sphincter thus formed is an extremely powerful 
one. Moreover, itis in constant operation. This explains 
in great part, no doubt, how it is that gases or food 
accumulated in abnormal quantity inside the stomach 
gain practically no exit by way of the cesophagus. Save 
in cases so rare that their occurrence may be reckoned a 
negligible quantity, everything collected in the stomach, 
deleterious or otherwise, is bound to pass out by ay of 
the pylorus. 

This one peculiarity alone in the build of the horse’s 
stomach must enormously influence the treatment of 
several disorders we are afterwards toconsider. For that 
reason I have given it prominence here. 


CHAPTER III 
HOW TO EXAMINE THE PATIENT 


PRESUMABLY a simple matter, this is, nevertheless, a 
subject that requires the most careful consideration. 
When conducting an examination that is to lead to the 
diagnosis of a case of ‘ colic,’ it should never be forgotten 
that it is always a case of the greatest gravity in the 
horse. 

On first sight, the pains of colic may often appear to 
be of the most simple character, and yet terminate fatally 
after the expiration of a few hours. I have repeatedly 
seen cases where the main symptoms on a casual 
examination were those that occasioned me no alarm. 
Nevertheless, one hour afterwards I have foretold the 
animal’s death. There is not the slightest doubt that 
the examination of the patient should always be of the 
most searching nature. If the examination is_half- 
hearted and hasty, an entirely erroneous opinion will be 
arrived at, and the horse, as a result, will suffer. 

Looking at the matter from a purely selfish point of 
view, the veterinarian should constantly have in mind 
the value of his reputation. By his clients, his standing 
as a clever, shrewd man of medicine will always be 
‘ largely based upon the correctness and precision of his 
prognosis in the cases they entrust to his care. As much 


22 THE COMMON COLICS OF THE HORSE 


of his precision in foretelling the termination of his case 
of colic will depend on the thoroughness of his first in- 
spection, it is clear that the manner of examination must 
be of the greatest importance. Of such importance have 
I deemed it, that I have devoted a chapter especially to 
its consideration. 

In the first place, I wish to lay the greatest possible 
stress on this fact. The examination must be a lengthy 
one; and my advice, especially to the young practitioner, 
is this: After your examination on the lines laid down 
in the following paragraphs, compose yourself, at any 
rate, for a wait of half an hour. 

From the patient you have no verbal description of the 
seat of pain, neither have you any information as to its 
character. Nevertheless, the sufferer, dumb as he is, 
will show you much if you will but carefully watch him. 
It is not fair to suppose that the animal will hold out for 
your inspection all possible symptoms of his malady 
during the first five minutes you are in his box. Con- 
sequently, you must watch him patiently until all his 
postures for affording himself relief have made him run 
the entire gamut of the symptoms that evidence his com- 
plaint. | 

This careful watching should be followed by a systematic 
mode of inspection. 

1. All possible history concerning the attack should 
be obtained from the owner or the attendant. The 
length of time the animal has suffered, the nature of his 
food, the manner of his attack, whether ushered in by 
shivering attacks or not, the nature of the water-supply, 
what emergency medicine has been administered, whether 
previously at work or rest, whether a quick or slow 
feeder, etc., are all important points in making the first 
inquiry. 


HOW TO EXAMINE THE PATIENT 23 


2. A rapid glance over the animal should next 
occupy the veterinarian before attempting to handle his 
patient. This generally reveals some special symptom 
that the animal will not show so well when he gives 
himself up to control. 

More especially is this latter advice to be followed 
when the patient is a young, unbroken colt, or an animal 
of an excitable, nervous temperament. Such patients, 
directly man commences interference, seem to possess 
the power of hiding the intensity of the pain they are 
suffering, and to stand so quietly as to fully deceive the 
rough and hasty observer. A few minutes’ careful 
watching in these cases will be productive of facts of 
more real diagnostic help than the most thorough and 
painstaking after examination. 

During this preliminary inspection such details as the 
following may be noted: The amount of injection of 
the nasal mucous membranes, the beat of the heart as 
counted by the jugular pulsations, the amount of 
tympary present, and the number and character of the 
respirations. 

The respiratory movements are valuable. In extreme 
distension of the abdomen the chest and diaphragm carry 
on the breathing, the action of the abdominal muscles 
being suspended. In enteritis and peritoneal inflamma- 
tion the same thing occurs. In rupture of the diaphragm 
the respirations are often similar to those of ‘broken 
wind,’ and, owing to the pressure on this muscle, the 
same appearance will be met with in extreme gastric 
distension. In all bad cases of abdominal disturbance 
the respiratory movements will be increased in number, 
sometimes enormously, and the character of each respira- 
tion altered from a noiseless movement to a gasping sob. 

All this may be noticed in the few minutes’ quiet 


24 THE COMMON COLICS OF THE HORSE 


observation I have advised, and the beginner may be: 
lieve me when I say that the owner of the animal is far 
more likely to be impressed with the man who makes a 
careful and systematic examination of this nature than 
with the man of rapid diagnosis. The latter he may 
admire, the former he will trust. 

Now and again you may meet with a client who is 
visibly struck with the ‘lightning diagnosis business,’ 
and, whenever you see a chance, and a safe one, of 
exhibiting this ability yourself, by all means take advan- 
tage of it with that particular client. It is not, how- 
ever, to be recommended as a usual plan of procedure. 
Methodical carefulness will tell the best in the long-run, 
and’will lead you into fewer blunders. 

3. The actual examination of the patient may 
now commence. 

The pulse, that grand tale-bearer in these cases, should 
be carefully noted both in regard to the number of beats 
and its general character—constantly frequent, or its 
number of beats only increasing with each paroxysm 
of pain, etc.; wiry and thin, or full and bounding, etc. 

While taking the pulse, the hand in the axilla should 
note the amount of perspiration present, and also ascer- 
tain the condition of the external temperature—whether 
the sweats are warm and comfortable, or chilly and 
deathlike. 

The vectal temperature, though not alone of diagnostic 
aid, should always be taken; for, considered in conjunc- 
tion with the pulse and number of respirations, it will 
sometimes prove of help in prognosis—e.g., see the 
chapter on Subacute Obstruction of the Double Colon. 

4. The examination of the abdomen should then 
proceed in the following manner : 

(1) By Palpation.—This method of examination will 


HOW TO EXAMINE THE PATIENT 25 


reveal to a very great extent the amount of tension or 
tympany present. In a bad case of intestinal trouble 
the whole of the abdominal muscles will feel hard and 
tense to the touch, conveying to one’s fingers the sensa- 
tion of a muscle in tetanus. Even in the flanks, where 

a certain amount of resilience is expected, the same tense 
condition is met with. 

In some cases palpation exposes the existence of pain or 
tenderness, as, ¢.g., In peritonitis and enteritis. In others 
the very reverse will be noticed, the pressure affording the 
animal an appreciable amount of relief. It is wise to add, 
however, that external pressure will not always cause the 
animal to exhibit signs that may be absolutely relied 
upon, It is often difficult to elicit symptoms of pain 
from our patients, but it is still more difficult to distin- 
guish between pain produced by pressure and ticklish- 
ness, restlessness, and fretfulness, which may simulate 
pain when pressure is brought to bear upon any part, 
particularly the abdomen. Still, by palpation the surgeon 
will be able to deduce a large amount of information, 
favourable or unfavourable as the case may be. 

(2) By Auscultation.—This aid to diagnosis should 
never be omitted. The sounds occasioned by peristalsis 
will sometimes be in abeyance or altogether wanting, and 
the appropriate remedy sufficiently pointed out. Or it 
may be that peristalsis is abnormally in evidence, as in 
the colic occasioned by the presence of fermenting foods. 
Both flanks should be auscultated, and also the region of 
the stomach. In the latter position evidence is some- 
times obtained as to the condition—tympanitic or other- 
wise—of that organ. If unduly full, regurgitations will 
often be heard that are so slight as to be easily missed by 
a mere observation of the oesophagus in the region of the 
neck, 


26 THE COMMON COLICS OF THE HORSE 


(3) By Rectal Exploration. — No grandiose affecta- 
tion of gvandesse should cause the surgeon to neglect 
this. Carefully and intelligently performed, it is one 
of the grandest means at our disposal for arriving at 
an accurate knowledge of the condition of the bowels. 
The bladder and a large portion of the posterior masses 
of intestines are well within reach, and the _ infor- 
mation gained by their examination will be found in- 
valuable. 

Notice should be taken as to the fulness or otherwise 
of the rectum, of the consistence of the fecal matter re- 
moved, whether semi-fluid or hard and solid, whether 
the removed lumps are covered with mucus or not, and 
whether of normal odour or comparatively stinking and 
offensive. 

It should be noticed also whether or not this organ is 
open (‘ballooned’) or exerting a clinging movement on 
the operator’s arm. In cases of acute obstruction— 
calculi, feecal matter, and twist—this clinging action will 
be particularly noticeable, and, with it, the operator will 
observe a painful straining on the part of his patient, 
together with the presence of tympanitic or impacted 
intestines in the pelvis. In many cases where this latter 
has been observed the obstruction has turned out to be 
in the single colon, and it may be taken as a general rule 
that in any case where the pelvis contains other bowels 
than the last portion of the rectum the practitioner has 
a case of a dangerous nature to deal with. 

To the right the operator should feel the head of the 
czecum and colon; their contents should not be hard, and 
on pressure the bowel should give; to the left and 
centre should be felt the pelvic flexure of the colon with 
its elastic contents, and to the centre may be found some 
of the small intestines. ‘They should not be distended 


HOW TO EXAMINE THE PATIENT 27 


with gas. No intestine, large or small, should exhibit 
pain or tenderness on pressure. 

(4) By Percusston.—This is performed by tapping the 
abdominal walls with the tips of the fingers of the right 
hand, with or without the left hand interposed. It will 
yield evidence relating to the contents and size of the 
viscera. Percussion over an intestine filled with gas 
gives a clear sound ; over one containing solid matter a 
dull sound. Where the contents are fluid the sound is 
modified. 

This will conclude the examination of the patient, and, 
although taking time to describe, its actual performance 
will be found to occupy but a very short time. 

The veterinary fledgling should always follow some 
such line of systematic inspection as I have here laid 
down. In course of time he will find that it has become 
part of his nature, and will be able to rattle through it in 
so short a time as to convey no impression of painful 
plodding to the outside observer. If possessed of tact, 
he will manage to maintain a running conversation with 
the owner the while he is doing it. He will become fond 
of his work, find it both interesting and instructive, and 
give all satisfaction to his client. 


CHAPTER 1% 


ETIOLOGY: GENERAL PREDISPOSING 
CAUSES 


REGARDING his predisposition to colic, the horse stands 
apart from almost every other animal. A brief considera- 
tion of such predisposing causes as are mentioned in this 
chapter will be quite sufficient to make us marvel that 
cases of ‘colic’ are not of even more frequent occurrence. 
At any rate, it will reveal quite enough to account for the 
enormous preponderance of these cases in veterinary 
practice. 

To commence with, there are several physiological and 
anatomical conditions, perfectly normal in themselves, 
which, nevertheless, are entirely favourable to the pro- 
duction of these disorders. 

In the first place, the relatively small capacity of the 
stomach compared with the animal’s size must be borne 
in mind, and, together with this fact, the normal process 
of digestion must be remembered. It is evident to the 
most casual observer that the small stomach of the horse 
cannot possibly contain the enormous amount of pro- 
vender that he is able to consume at one meal. As a 
matter of fact, it has been proved to us that at a certain 
period of stomach digestion the amount of food passing 
out of the pylorus into the intestine equals the amount 
entering the stomach by the cesophagus. Notwith. 


GENERAL PREDISPOSING CAUSES 29 


standing this provision of nature to avoid gastric 
impaction, it is easy to understand that a quick or 
greedy feeder may so bolt his food as to bring about-one 
of two conditions: either impaction of the stomach with 
food insufficiently acted upon by the salivary fluids, or 
the pouring out into the intestine of a large amount of 
improperly digésted material from the stomach. The 
mere fact of its being imperfectly digested in the stomach 
leads to other troubles in the intestines. The material 
there is unable to become properly assimilated, and the 
result is either a troublesome diarrhoea or, what is more 
frequent, a condition of stasis or obstinate impaction. 

In addition to this, we may carefully consider the 
tremendous volume of the large intestines, their thin and 
delicate walls as compared with the enormous amount of 
bulky material they are called upon to deal with, and, 
finally, their great length. This done, we shall not be 
much astonished at a fairly frequent occurrence of gastric 
and intestinal disorders in the horse. 

Again, notice what a careful dissection of the stomach 
reveals (pp. 9 and 17). It is an anatomical fact that its 
very build is a distinct bar to the act of vomition. Con- 
sequently, no matter how sick the animal may feel, no 
matter the amount or irritancy of any deleterious matter 
he may have swallowed, there it must remain, or travel 
the whole length of the sensitive and absorbent surfaces 
of the intestines before gaining exit from the body. The 
anatomical facts that lead to that statement are as 
follows: 

1. The small size of the stomach and its want of 
contact with the abdominal walls. This is a decided 
hindrance to its effectual compression. 

2. The narrowness of the cesophageal opening ; 
the thickened and contracted arrangement of the fibres 


30 THE COMMON COLICS OF THE HORSE 


of the cardiac extremity of the cesophagus; the oblique 
manner in which the latter enters the gastric walls; the 
peculiar arrangement of the folds of mucous membrane 
lining its interior; and the presence of the cardiac 
sphincter, already described on pp. 9 and 20—these are 
all factors in bringing about complete occlusion of the 
cesophageal opening. 

3. The pyloric outlet—comparatively distended— 
lying close to and below the sealed cesophageal inlet. 
That being so, it naturally follows that any compression of 
the gastric walls forces the stomach contents with equal 
strength towards both the cesophageal and duodenal 
openings. The contained material finds the readiest 
road of exit—the pylorus. The offending material, which 
may have given rise to inclination to vomit, is passed by 
adverse force of circumstance into the intestine. 

Proceeding with the intestines themselves, we note 
first of all the formation of the so-called ‘ duodenal trap,’ 
as illustrated on pages 10 and 11. In cases of distended 
stomach or intestines this S-shaped piece of intestine is 
compressed and its contents rendered stationary. This 
is undoubtedly another great factor in the production of 
gastric and intestinal obstructions, with their attendant 
colicky pains. Following this, we observe the differences 
in the size of the various parts of the colon, together with 
its several flexures, and note also the length and com- 
paratively free location of this organ and the czecum. 
Taken collectively, these circumstances, though quite 
normal in themselves, must still be held to be favourable 
to the production of colic. 

Again, I think every practitioner will bear me out 
when I say that age is frequently a predisposing cause of 
these complaints. With advancing age there is not the 
amount of what is commonly called ‘tone’ in the system. 


Vd 


GENERAL PREDISPOSING CAUSES 31 


The teeth do not perfectly perform their proper function, 
and the food is passed on in a half-masticated state, and 
without the requisite admixture of salivary fluid. The 
digestion is far from being so quick, and a large amount 
of bulky food is less easily disposed of. The circulation, 
too, is not so free, in consequence of which there is less 
gastric juice secreted—often not sufficient—and impaction 
is the result. 

Here, also, attention may be given to the time occupied 
in the passage of food through the digestive canal of the 
horse. 

Henry Jarvis, in 1872, in four experiments, observed 
the following : 

Horse No. 1, fed on oats, performed half an hour’s 
exercise, and passed oats in twenty-four hours. 

Horse No. 2, fed on oats, performed a nine miles’ 
journey, and passed oats in twenty-two hours. | 

Horse No. 3, fed on oats, kept quiet in stable, and 
passed oats in twenty-seven hours. 

Horse No. 4, fed on oats, kept quiet in stable, and 
passed oats in twenty-seven and a half hours. 

These periods, I need hardly add, are comparatively 
short, and the average time has been estimated by other 
authors to be nearly four days. In either case the time 
is wonderfully short. This fact must be remembered in 
close connection with another: I refer to the nature of the 
horse’s food. We know quite well that a very great pro- 
portion of his provender is of an indigestible nature, and 
that a very large amount of the material taken into his 
body is excreted unchanged. We know equally well that 
this excretion is going on with almost mathematical 
regularity throughout the day. In other words, the 
horse in health requires to empty his rectum eight to 
ten or twelve times during every twenty-four hours. 


-- THE COMMON COLICS OF THE HORSE 


It requires but a few moments’ consideration to dis- 
cover what a great bearing this has upon the frequency 
of his attacks of colic. I have repeatedly seen cases 
where, without actual or complete stasis, the horse’s 
bowels have performed only one evacuation daily. In 
every case so observed dull colic pains have supervened 
before the expiration of twenty-four hours. 

Compare this with the human subject in health. The 
average man is able to comfortably rid himself of his 
twenty-four hours’ excreta by the passage of one stool 
daily. This means that the horse’s bowels perform in 
one day what those of a man perform in seven or eight, 
and that cessation of the act of defecation for twenty- 
four hours in the horse is practically equivalent to a 
cessation of seven days in man, ‘That is putting it at its 
lowest computation. 

In view of that, it 1s easily understood why it is that 
pain follows so rapidly on apparently slight stasis of the 
bowels in the horse. We may now see how it is that 
cessation of the normal act of defecation for twelve 
hours, or even less, is quite sufficient to bring on symp- 
toms of pain, except under extraordinary circumstances. ~ 
It is this that renders equine colics of such serious 
importance to the veterinarian. It explains in great 
measure the rapid and oftentimes fatal course they run, 
and impressively points out the urgent necessity for 
prompt and precise remedial measures. ‘This, more than 
anything else, should induce the veterinary surgeon to 
carefully weigh his data before jumping at a diagnosis. 
Above all, it should cause him to deliberately ponder, and 
perhaps stay his hand, before administering those agents which 
tend to kill pain, but at the same time tightly lock the bowels. 
He may exhibit opiates or sedatives with the most 
humane of all objects—that of alleviating agonizing 


‘ ters 
3 ’ 


GENERAL PREDISPOSING CAUSES 33 


suffering in a dumb animal—but he should never forget 
that his first duty is to preserve life. I have remarked 
thus fully upon this in order that I might point out as 
conclusively as possible this fact. Of all the predisposing 
causes to attacks of colic, this regular frequency with 
which the horse evacuates the contents of his bowels is 


_ to be looked upon as of supreme importance. 


Hereditary Predisposition.—‘ Are diseases of the 
bowels hereditary? Why not? Cannot an amount of 
susceptibility be transmitted from parent to progeny ? 
May there not be a diathesis transmitted, by which the 
structure of the bowels is more susceptible to disease in 
some than in others? If cases were carefully traced 
back, might we not find that the sire or the dam had 
been subject to some disease of the bowels ?’ 

These are questions asked by a practitioner in the 
Veterinary Journal. To all of them I can confidently 
answer in the affirmative. I have frequently been told, 
when attending a case, that the animal’s mother was 
always subject to colic. ‘Ay, and her mother died from 


_ it, too !’is often the close of the owner’s remarks. Seeing 
that as many as 50 to go per cent. of the total cases in 


some practices are those of colic, it is no great argu- 
ment, I admit, to say that because one patient’s mother 
died from colic the offspring of other. victims of the 
disorder must necessarily inherit a fatal predisposition. 
Nevertheless, the point that has struck me is the 
frequency with which one hears the word ‘always’ 
inserted. 

With a certain amount of hesitancy, I also put down 
‘weather’ as a predisposing cause of these complaints, 
We all know the way in which the weather exerts an 
effect—baneful or beneficial—upon ourselves. It is only 
fair to add that these same influences are at work among 

2 


34 THE COMMON COLICS OF THE HORSE 


the lower animals. “In short, every practitioner must 
have noticed the prolific crop of colic that speedily 
follows a spell of cold, showery weather, when previously 
all has been warm and dry. 

Temperament as a Predisposing Factor.—This 
should really come under the heading of heredity. All I 
need add to what I have already said in that paragraph 
is that I have frequently noticed that animals of a 
sluggish, lymphatic nature are more liable to repeated 
attacks of colic than are others. 

Last, but by no means least, in this lengthy category 
of predisposing causes comes a reference to the mucous 
membrane of the intestines. I think no one will deny 
that the delicate lining of the bowels in the horse is 
much more sensitive to deleterious matters than that 
of any other domestic animal. In proof of which, 
witness the agonizing pains that accompany the least 
disturbance of his alimentary tract, and the rapidity with 
which the animal succumbs. Witness, also, the rapid. 
and fatal effects of comparatively small doses of irritant - 
poisons: the animal’s dejected and downcast demeanour, 
and his absolute indifference to everything except the 
torturing pain which is rendering his case hopeless and 
pitiable in the extreme. 

This chapter, then, details some, though not all, of 
those causes that tend to the production of equine colic. 
The practitioner need not, however, be dismayed by their 
apparent infinity. Although, for anatomical and physio- 
logical reasons, the horse is fearfully liable to paroxysms 
of these agonizing pains, the veterinarian should en- 
deavour to remember that many of these predisposing 
causes are often energetically helped into being active 
ones by the crass stupidity of the animal’s attendant. 


SHarlERK V 


ETIOLOGY: GENERAL EXCITING 
CAUSES 


In this chapter I intend to briefly enumerate such 
exciting causes of colic as will render repetition un- 
necessary in future pages. As far as possible I shall 
describe those circumstances and influences that are 
commonly at work in the production of these disorders. 
It will save me the trouble, and my readers the annoy- 
_ ance, of repeating several times the same matter under 
’ different headings. 

It matters but little in what district the practitioner of 
veterinary medicine may pitch his tent, he will be certain 
to find that far and away the most common cause of the 
equine colics is the one that may be best described by 
the single word ‘domestication.’ The horse, probably 
more than any other animal, is under man’s control and 
at man’s disposal. So long as he is allowed to roam the 
fields, gathering his food in a rough and scanty manner, 
taking his exercise as he himself sees fit, and resting 
when nature dictates, so long will he remain a picture of 
perfect health, Man steps in, and the colt’s life of 
freedom is at an end. 

The nature of his food, its quality and quantity, and 
the frequency with which he may be allowed to partake 

3—2 


36 THE COMMON COLICS OF THE HORSE 


of it—all these circumstances are entirely under man’s 
control, often caprice. His manner of living may vary 
from several days per week of a constrained idleness in 
the stable—with its attendant evils of sluggish liver, 
swelled legs, uncalled-for corn, and unnecessary fat—to 
an enforced life of yearly labour far beyond his endurance, 
with a lack of proper maintenance, and a disgraceful 
neglect of his comfort when ailing. ‘The ill effects of 
domesticating the horse, so far as they tend to the 
production of colic, I purpose describing under separate 
heads as follows: 

(2) Food.—There are several reasons that lead one 
to ldok upon the food as a prominent factor in the 
causation of colic. In the majority of cases, unless the 
horse be one of a large stud, where the business of 
feeding is reduced almost to an exact science, this food 
is selected without any regard for the proper balance 
of its constituents as a suitable, easily digested, and 
economical diet. Even in cases where some little atten- 
tion is paid to this essential by the owner, his well-meant 
intentions fail in that the animal’s attendant will use far 
too much of the food so chosen, or, in others, the niggard- 
liness of the owner prevents the requisite amount being 
given. 

In my own district it is absolutely impossible to arrive 
at any just measure of the amount weighed out per diem 
to each horse. The owner will tell you one thing, the 
men another, and the horse, by his illness, contradict 
both. Oats, the food pay excellence for the horse, is very 
seldom used even in country districts. It is sent in bulk 
to market, and maize purchased in its stead. In agricul- 
tural districts the maize has added to it whatever else 
may by chance be on the farm. More often than not 
this is wheat or barley—two notoriously bad foods for 


GENERAL EXCITING CAUSES 37 


horses. If these be not available, then bran is the next 
obtained. Bran mixed with maize forms much _ too 
laxative a diet for the horse in work; it is certainly not 
economical, and is, moreover, a frequent cause of an 
attack of colic. 

Nor must we forget the enormous quantities of foreign 
feeding materials that are poured into our markets in 
these days of rapid trans-oceanictransit. It is principally 
the equine dwellers in our large towns that are likely to 
suffer from their introduction, and we have had startling 
evidence of the ill effects of these materials in out- 
breaks of such serious importance as ‘poisoning by 
muttars’ and the conveyance of anthrax. Putting 
diseases of that nature on one side, it is a well-known 
fact that cargoes of such materials are notoriously full of 
dust and other foreign substances—e.g., scraps of iron, 
sand, stones, etc. | 

In some districts it is a common practice to feed the 
animals once weekly with food that has been boiled, or, 
when making them up for sale, to diet them largely on 
it for several weeks prior to selling. Though probably 
more easy of digestion, I fear such food is often ravenously 
bolted, and in that way lays the foundation for colic. 

The several questions bearing on the matter of food, 
its economic value, mode of administration, etc., are 
various and widely differing. In the hope of rendering 
this little volume of direct practical value to the prac- 
titioner of veterinary medicine and to the stock-owner, I 
have added an appendix entering more into detail on this 
matter ; there is, therefore, no need for me to enlarge 
upon it here. 

(}) Water.—Personally, I am not of the opinion that 
this can often be looked upon as the direct cause of colic. 
Unless it is sufficiently impregnated with the salts of 


38 THE COMMON COLICS OF TH# HORSE 


calcium to lead to the formation of calculi, which by 
their presence act mechanically as obstructive agents, 
I do not think we need often consider the water-supply 
when treating a case of colic. There is one exception 
of importance: cases where the water is likely to be 
contaminated by passing through new leaden pipes, or 
stored in leaden cisterns, or in tanks whose joints have 
been cemented with a putty composed largely of lead 
carbonate. 

Since these statements forbid us to regard the water 
itself as a cause of colic, we are compelled to look deeper 
into the matter. We must endeavour to trace its ill effects, 
if any, to the manner or time of its administration. 

Firstly, there is but one mode of allowing it that need 
be considered at all seriously. Should the water be 
given excessively cold to an animal-greatly heated with 
exercise? As there is nothing definitely proved upon 
this point, it remains largely a matter of common-sense 
reasoning based upon experience. It must be remem- 
bered that an animal just returned from violent exertion 
has had his system greatly depleted of fluid. That this 
fluid needs replacing is beyond question. Personally, I 
am led to believe that while the animal is still warm is 
the best time to allow him to have it. The way I reason 
it is this: Prolonged muscular exertion has robbed the 
body of a large amount of combustible material; this 
certainly requires to be given back again in the form of 
food. The animal will not eat sufficiently until his thirst 
has been satisfied, therefore the water should come first. 

Why not allow him to cool first, then water and after- 
wards feed him ? That question may be answered thus: 
After violent exercise the body temperature rapidly sub- 
sides—at any rate the feeling of warmth does; in other 
words, there is a corresponding reaction. If after this 


GENERAL EXCITING CAUSES 39 


reaction has set in—1.¢., when the animal begins to feel 
chilly—he is allowed to drink freely of cold water, his 
system is sure to feel its effects with double intensity, 
and a condition of the body will be induced decidedly 
unfavourable to the proper digestion of the feed to follow. 
The temperature and high degree of functional activity 
occasioned by the exercise should be utilized to raise the 
temperature of the requisite amount of water the system 
requires before reaction has commenced; the animal is 
then enabled to take in the necessary fuel for further 
combustion. These remarks do not apply to an animal 
that has returned to his stable in a state of great 
exhaustion or fatigue. In my own stables the above has 
been the custom for a great number of years. Never 
once have I been able to attribute to it any ill effects. 
It must not be forgotten, however, that custom in 
watering animals should never be quickly changed. 
Anyone who has accustomed his steed to a different 
procedure from that mentioned should not suddenly 
alter it. 

Secondly, we come to the time of its administration. 
Should horses be watered before, between, or after feed- 
ing? This again opens up a question regarding which 
nothing is clearlysettled. In an attempt to determine it, 
Professor F. Tangl, of the Veterinary College, Budapest, 
offers some interesting experiments and conclusions.! 
Without detailing his experiments, which would encroach 
too far on my space, it will suffice to give this gentle- 
man’s summary. He says: 

‘ Horses may be watered before, during, or after meals 
without interfering with the digestion and absorption of 
the food. All these methods of watering are equally 


1 Journal of Comparative Pathology and Therapeutics, vol. xv., 
p. 21. 


40 THE COMMON COLICS OF THE HORSE 


good, and each of them may be employed according to 
circumstances. It is obvious that certain circumstances 
may make it necessary to adopt one or other method. 
I need only mention as an example that, after severe 
loss of water, such as occurs in consequence of long- 
continued exertion, the animal should always be allowed 
to drink before it is fed, as otherwise it will not feed 
well. Although all methods of watering are equally 
good for the horse, it is not desirable to change un- 
necessarily from one method to another. Animals, or 
at least some of them, appear to be not altogether in. 
different to such a change. We observed in our experi 
ments that whenever a change was made from the plan 
of watering after food to that of watering before, the 
appetite fell off for some days; not that they did not 
consume the whole of the food given to them, but for 
some days together they did not eat with the same 
avidity, and took a longer time to consume their rations 
completely. A similar effect was not observed when the 
change was from watering before to watering after food, 
or from watering after to watering during meals, or when 
the change was in the opposite direction to the last. 
It is possible that this method of watering before food, 
until the animal has become accustomed to it, produces 
a certain feeling of satiation. Further experiments would 
be necessary to show to what extent, apart from the bad 
effects of an excessive consumption of water, the plan of 
watering after meals acts injuriously on digestion in the 
case of foods that are difficult of digestion or tend to 
induce tympany, such as ‘grains provided with an 
envelope.’ 

(c) Errors in the Proper Distribution of Work, 
Rest, Watering, and Feeding.—Of all the bane‘ul 
effects of domesticating the horse that tend to the pro- 


GENERAL EXCITING CAUSES 4! 


duction of colic, by far the greater part will be found 
under this heading. 

The small stomach of the horse offers a fair reason to 
suppose that it should be often filled during the day, in 
_order that the amount of ingesta required by his volumin- 
ous intestines may be adequately provided. Observation 
of the horse’s natural habits sufficiently points this out, 
and yet how often we see this teaching of nature grossly 
ignored. Percivall, with his usual terseness of argu- 
ment, suggests that when the natural habits are changed 
for new ones, by confirmation of time and usage these 
come to appropriately take the place of those ordinarily 
natural. He is evidently referring to the ‘ three meals a 
day ’ system of feeding the horse, which custom has come 
to substitute for the animal’s constant grazing when at 
large and at pasture. Probably, if man were content to 
allow even these necessary three meals, and at regularly 
fixed hours, cases of colic would be far less numerous. 
Such, however, is not the case. Percivall himself goes 
on to remark: ‘ How often do we see horses, hunters 
especially, taken to work at eight or nine o’clock in the 
morning, and not returned to their stables before five, six, 
or seven o'clock at night.” He then proceeds to point 
out that the well-bred horse will endure this long fasting, 
and subsequent repletion, with comparative impunity ; 
that coarse-bred ones and cart-horses will not, but suffer, as a 
vesult, from stomach troubles.1 As an example of the way 
in which the animal’s constitution is sometimes abused in 
this respect, I cannot do better than quote from a former 
article of mine referring to the feeding of horses in my 
own district :? 

‘Whether the horse be in hard, every-day work, or 


1 The italics are mine.—H. C. R. 
% Journal of Comparative Pathology and Therapeutics, vol. Xili., p. 27. 


42 THE COMMON COLICS OF THE HORSE 


out of harness altogether, he has at the customary hours 
the same quantity of food thrown into his manger. 
These hours, by-the-by, are only twice daily—one large, 
long feed at daybreak, and another large feed towards 
evening. Then, again, in Lincolnshire, the district I am 
speaking of, there is often one long spell of work from 
seven o’clock in the morning until three in the afternoon, 
during which time no break is made to refresh the 
animals; no water to drink; no nose-bag to their faces. 
A break they certainly get at eleven o’clock, when they 
stand in a profuse perspiration, still harnessed to the 
harrow or the plough in the middle of a field, their heads 
down, and a biting, cutting, cold east wind, from which 
in the Fens there is not a particle of shelter, blowing 
about them, while the man in charge, under the lee of 
a close-cut hedge, sits stolidly munching his lunch. 
Again, without bite or sup, the horses resume their work 
and remain at it until three. Then, in a state of exhaus- 
tion and fatigue, when the powers of the digestive tract 
are probably at their lowest, the animal is placed in front 
of an enormous feed of indigestible, bulky food. After 
filling his stomach, he is allowed to drink heartily of the 
water he has perhaps been craving for all day. Every 
practitioner in this district must well know the Monday 
evening crop of colic. Sunday’s rest, Sunday’s gorging, 
and Monday’s day of ceaseless work and fasting, all 
combine to produce the colic of Monday evening. 

‘This is the state of things existing in the winter 
months, with, perhaps, the break in field operations 
occasioned by a spell of frost, which again only means 
another period of gorging in the stables. In the summer 
months the animals live the greater part of the time 
in the open, and the veterinary surgeon’s sphere of use- 
fulness, for a time, is limited, with one exception. It is 


GENERAL EXCITING CAUSES 43 


no uncommon thing for a farmer to take his nag straight 
away from pasture, give him a feed of corn, and drive 
him, full of grass, long-coated, ungroomed, and _ per- 
spiring, six, eight, or ten miles to the nearest market 
town. Here he is allowed to stand huddled up with 
several of his fellows in a dirty and badly-ventilated 
stable, from eight, nine, or ten o’clock in the morning, 
until three, four, or five in the afternoon, during which 
time he has not eaten or drunk a mouthful. He is then 
geared to the cart again, and does the return journey. 
His reward for that, on reaching home, is an extra large 
feed of corn, given at a time when I unhesitatingly say 
he should have less ; after which he is again turned out 
into the field for the night, to stand, perchance, the whole 
of the time in a pouring rain.’ | 

Referring again to Percivall’s observed immunity of 
the hunter, it must not be forgotten that this animal, 
as compared with the cart-horse, has the advantage of 
the excitement of the chase. For him it has not beena 
day of ceaseless, unvaried toil. Every huntsman knows 
full well that the steed, as much as the rider, partakes of 
the exhilarating influences engendered by the sport. In 
other words, it is the matter of temperament, already 
referred to in Chapter IV. 

The Influence of the Time of Day on the 
Production of Colic.— As far as I remember, 
General F. Smith was the first to point out the 
enormous number of colic cases that occurred after the 
hour of 2.30 p.m., as compared with those occurring 
earlier in the day. Following his example, I have 
tabulated my cases, and the table on p. 44 will 
show that the majority of cases in this district are 
attacked between the hours of 12 noon and 7 p.m. 
inclusive. 


44 THE COMMON COLICS OF THE HORSE 


Hour. Cases. Hour. Cases; 4 Hour. Cases 
4a.m. O I2 noon 3 8 p.m. re) 
a lix I I p.m. fe) 9. fe) 
a. 23 2 ee oO KO: 53 fe) 
7 3% I a ou 2 Ir ;; O 
Ore fe) roe 3 1z2midnight o 
en fe) Bima fe) I a.m. O 
50). = Oo Go . 2 ee fe) 
Bis Ses 2 Pes, 2 4 O 


In this district I account for the preponderance of 
cases after noon by attributing it to the long stretch of 
work without food, and the ravenous feeding on bulky, 
indigestible material immediately afterwards. I havealso 
noticed that the great bulk of the cases occurring in the 
early morning—say from 4 or 5 a.m. until noon—are 
those that turn out to be fatal. 

Other and Various Exciting Causes of Colic. 
—Ingestion of food contaminated with sand or gravelly 
material, or containing substances (scraps of iron, wire 
nails, etc.) likely to form nuclei of calculi, Catarrh 
of the intestines often accompanies influenza and many 
respiratory affections, and animals convalescent from 
these maladies have a weakened digestive tube, and are 
prone to constipation and impaction. Aneurism of the 
anterior mesenteric artery, due to the presence of 
strongyles, frequently determines the impaction of feces, 
owing to the interference with the blood-supply to the 
cecum and colon. Pieces of the thrombus break off, 
and effectually plug smaller arteries supplying, mainly, 
parts of the cecum and colon. In the anemic area of 
bowel thus produced peristalsis is diminished, or perhaps 
altogether in abeyance. As a consequence we get great 
weakness, or even paralysis, of that portion of the 
bowel, with a tendency to stasis of its contents, and 
obstruction from fecal accumulations. Other factors 
that, directly or indirectly, tend to produce. constipation 


GENERAL EXCITING CAUSES 45 


and fecal obstructions are: large quantities of omental 
fat, pressure of tumours, and repeated pregnancies, dis- 
tending and weakening the abdominal parietes. For my 
own part, I am quite satisfied that the mere presence of 
the foetus, in the later stages of gestation, is mechani- 
cally accountable for many of our cases of colic, par- 
ticularly obstructive. Occupying, as it does, a large 
proportion of the abdominal cavity, it must interfere 
considerably with the actions and movements of the 
intestines ; that is leaving out of the question entirely 
the fact that a large portion of the blood-current of the 
mother is necessary for its development. 

In these days, too, the rapid strides of bacteriology 

must not be forgotten. I should not be surprised at any 
moment to pick up one or other of our veterinary journals 
and read that some eminent scientist had discovered a 
specific germ for such of our cases of colic as run 
the rapid and fatal course of from twelve to twenty-four 
hours only. One would imagine that in cases of twist, 
for example, the pain, however agonizing, would not of 
itself be sufficient to kill the patient. To my mind there 
is only one solution that fairly fits the case—bacterial 
infection of the blood-stream commencing from the 
intestines. More especially do these remarks apply to 
what is known among veterinarians as‘ enteritis.’ That, 
however, I will deal with in the chapter reserved for its 
discussion. 

In this chapter I think I have now indicated sufficient 
to direct the veterinarian’s attention to the errors he 
sees daily perpetrated around him. Customs vary in 
different counties, and it is sometimes only necessary to 
step across an imaginary boundary to see manners and 
usages totally unlike those to which one has been accus- 
tomed. It is, therefore, quite impossible that I can dis- 


46 {TE COMMON COLICS OF THE HORSE 


cuss them all. It remains for the practitioner to take 
the initiative in his own district, and to fight strenuously 
and continuously against customs and usages which his 
better education and wider experience show him to be 
wrong. 


PaaPrerR Vi 


GASTRIC IMPACTION 
(GORGED STOMACH, GRASS STAGGERS, 
OR STOMACH STAGGERS) 


Definition.—Under this heading I purpose describing 
a disorder which is familiarly known to veterinarians as 
‘stomach staggers’; and throughout this chapter I wish 
to indicate that I am referring to that state of the stomach 
in which it is overfilled or gorged with food. No 
tympany. In other words, it is a condition of affairs in 
the stomach comparable to, and agreeing in every way 
with, that state of the intestines known as ‘ subacute 
obstruction,’ or ‘ impaction.’ 

Williams, in his ‘ Principles and Practice of Veterinary 
Medicine,’ looks upon this disorder as merely a symptom 
attending inflammation of the brain and its meninges, 
and concludes his paragraph on its definition in these 
words: ‘ The most common form of congestion of the 
brain and its membranes, both in the horse and horned 
cattle, is that called stomach staggers, or grass staggers, 
a disease which sometimes rages as an enzootic.’ 

I cannot say that I agree with him. Rather I prefer 
to turn to an older writer (Percivall), and quote again: ‘A 
stomach surcharged with food, without any accompany- 
ing tympanic distension, does not appear to occasion any 


48 TIE COMMON COLICS OF THE HORSE 


local pain, but operates that kind of influence upon the 
brain which gives rise to symptoms, not stomachic, but 
cerebral; hence the analogy between this disease and 
‘‘ staggers,’ and hence the appellation for it of ‘* stomach 
staggers.””’ 

It may be that the total absence of colicky pains has 
led to the actual seat of mischief being overlooked, 
and the symptoms proceeding therefrom arrogated to 
some abnormal condition of the brain. It is not for me 
to deny that certain conditions of the brain or its coverings 
may give rise to symptoms simulating those aroused by 
a gorged stomach. Nevertheless, I feel it is only right 
to point out that in many cases a searching inquiry into 
the history will plainly indicate that many of these 
attacks have the origin of their symptoms in an abnor- 
mally gorged condition of the stomach. Unless we are 
fully decided upon this point, our treatment of a particular 
case is sure to be at fault. 

Causes.—Remembering the inability of the horse to 
vomit, we shall not be surprised to find that excessive 
cramming of the stomach after a long fast is a frequent 
factor in determining this complaint. It is not, however, 
so much the quantity of food that needs consideration as 
its nature. A plentiful supply of succulent, easily-bolted 
herbage is the one food that is extremely likely to bring 
on an attack. It matters not whether the herbage be 
rye-grass, clover, vetches, or ordinary mixed pasture, 
this fact remains: An unlimited supply of tasty, suc- 
culent provender will cause some animals to go on feeding 
long after their actual wants are satisfied, and the result 
is an impacted state of the stomach with a mass of food 
it is unable, mostly mechanically, to deal with. 

Regarding what has been written concerning some 
narcotic quality of over-ripe grasses (Dick), | am quite 


GASTRIC IMPACTION 49 


prepared to grant that in some cases such may be the 
exciting cause. That admission, however, does not 
detract one iota from what I have already said. If one 
is to always accept that explanation of the case, how is 
one to account for those odd attacks occurring in the 
winter months, when the whole of the provender is dry 
corn and chopped wheat or oat straw? I have seen 
cases where the diet was wholly composed of the foods 
I have mentioned. 

Again, how is it that one animal out of five or six, all 
eating the same food from the same manger, is sometimes 
seen to be attacked? No explanation of the latter case 
can be found save the fact that the animal under 
observation is a notoriously ‘ greedy feeder.’ 

Symptoms.—Percivall sagely remarks: ‘The un- 
naturally filled stomach produces for the first time a 
sense of satiety; the horse grows heavy and drowsy, 
reposes his head upon the manger, falls asleep, and makes 
a stertorous noise.’ 

His whole appearance is dull and listless, and the 
abdomen is visibly distended, though not to the extent of 
causing pain. The pulse becomes full and bounding 
and its number of beats below the normal, while the 
respirations are heavy and slow. The bowels become 
more or less torpid, though the rectum is frequently 
found full of fecal matter. The torpidity seldom or 
never runs the length of actual stasis or obstruction. 
Commonly the visible mucous membranes are injected 
and tinged with yellow. The mouth is dry and clammy, 
and its odour offensive. Theve ave no evuctations of gas 
and no attempts at vomition. When urged to move, the 
animal does so in a semi-unconscious manner, reeling 
and staggering in his walk, and blundering blindly into 
any object near him. 

4 


50 THE COMMON COLICS OF THE HORSE 


Allowed to stand, he remains quiet, with head down 
and eyes half closed, a sudden rousing causing him almost 
to fall to the ground. 

Diagnosis.— Knowing that symptoms like the above 
may be the result of some lesion in the brain itself, the 
veterinarian is urged to make a careful inquiry into the 
history of his case. That done, the diagnosis becomes a 
comparatively simple matter. Receiving an account of 
an abundant feeding after a long fast, learning that the 
animal has been in a position to glut himself with food of 
which he is especially fond, or hearing that he is always 
a voracious and greedy feeder, will lead the veterinary 
surgeon to be on the alert. Either of these circum- 
stances, together with the symptoms presented, will - 
render any chance of error small. Proceeding further, 
and by negative reasoning placing aside this and that 
article of diet as containing no narcotic principle, the 
surgeon advances with his diagnosis, and finally arrives 
at a correct decision. 

Prognosis.—My experience leads me to the con- 
viction that this, in most cases, may be favourable. 
The absence of tympany and the continuance of peri- 
stalsis, though it be but slight, justifies that statement. 

Treatment.—This must be mainly directed to the 
conservation and assistance of such favourable conditions 
as are present. It should be borne in mind that the 
occurrence of tympany would quickly lead to arapid and 
fatal termination. 

An agent which will be found to prevent that, act as 
an antiseptic, and exert an excito-secretory action on the 
intestinal tract, is to be found in sodium chloride. Should 
that be the drug selected, it may be given either in the 
form of a ball or a draught. ‘Those who prefer it may 
use instead hydrochloric acid in small and frequently 


GASTRIC IMPACTION 51 


repeated doses, taking care to keep it well diluted. 
The administration of these two drugs will be best 
followed by the exhibition of an oleaginous purgative. 
It will act beneficially in two ways, serving both to 
empty the overladen bowels and to counteract any 
irritant or corrosive effects of the salt or acid. The 
lethargy of the nervous system should, at the same time, 
be overcome by the judicious use of nux vomica, in 
this case preferably given in the form of the tincture, 
owing to the likelihood of its becoming more rapidly 
absorbed. | 

Another and perhaps more suitable line of treatment 
is the administration of an aloetic purgative, together 
with the use of the alkaline stimulants (ammonia com- 
pounds), which, while acting as cerebro-spinal stimulants 
and urging the circulatory and secretory organs into 
activity, also prevent the formation of gases. 

In all cases, no matter what the medicinal agent em- 
ployed, the animal should be well rugged down, in order 
to promote warmth and the action of the remedies 
adopted. At the same time, he should be kept slowly 
walking to overcome the lethargy and tendency to som- 
nolence. The use of copious warm and stimulating 
enemata is beneficial, and should always be persisted in. 


OF IL Lik 


4—2 


CHAPTER Ye 


GASTRIC TYMPANY: GASTRECTASIS, OR 
DILATATION OF THE STOMACH 


Definition.—That condition of the stomach in which 
it is abnormally distended with gas, the result of fer- 
mentation of its contents or the introduction of air from 
without. 

This disease, by no means a rare one, appears to have 
been but little noticed by veterinarians, if we may judge 
by the paucity of literature relating to it. A redeemnig 
feature presents itself in that the reported cases, though 
few in number, are extremely well stated, and leave no 
doubt in the mind of the reader that the authors are 
well acquainted with the condition they describe, cog- 
nisant of the real nature of the complaint, and convinced 
of the dangers attending it, 

_ Of all the gastric and intestinal disorders we are able 
to diagnose this is one of the most rapid, and at times 
one of the most fatal, the veterinary surgeon is likely to 
meet with. The patient is in those extreme agonies of 
pain that quickly run on to death, and nothing but a 
prompt recognition of his complaint and the administra- 
tion of suitable remedies will bring about a favour- 
able issue. A few hours’ indecision will place his 
chances of life, already small, beyond all hope. This 
latter statement is rendered the more important by the 


GASTRIC TYMPANY 53 


fact that the attack is oftentimes treacherous at the out- 
set, the mildness of the premonitory symptoms effectually 
masking all possibility of the fearful, agonizing spasms to 
follow. | 

Percivall, though including both this disorder and 
intestinal tympany in one description, still manages to 
steer clear of ambiguity, and leaves his reader fully in- 
formed that tympany of the stomach, and stomach only, 
is often to be dealt with in veterinary practice. Hesays: 
‘In the horse, however, who has no vumen, veritable hove 
is arare occurrence. ... I shall never, probably, see so 
many blown or hoven' horses as I witnessed in the march 
of the British army from Waterloo to Paris in 1815. A 
brigade of horses had been allowed to feed in a field of 
growing wheat, and the consequences were that several 
amongst them swelled in the body, and turned almost 
frantic with pain, and died.’ 

Other authors have also given excellent descriptions of 
this disorder. Mr. Henry Thompson, Aspatria, under 
‘Rupture of Stomach’ beautifully describes a case which 
had its starting-point in this condition, Here is his 
description: ‘This horse was reported ill about ten 
o'clock in the morning, and, on examining him, I found 
that he was apparently suffering from flatus.1... Treat- 
ment was continued, but without any beneficial effect, 
and early in the afternoon the “ eructation” was noticed, 
the pulse rapidly assumed the “‘ running down ” character, 
great prostration came on, and the horse died about 
eight o’clock in the evening. From the time when the 
eructation appeared no medicine was given, as from my 
experience in former cases I was as certain as it was 
possible to be that a rupture had occurred.” 


* Phe italics are mine.—H. C. R. 
4 Veterinary Journal, vol, iii., p. 259. 


54 THE COMMON COLICS OF THE HORSE 


Mr. Alfred Broad, too, relates a case of acute gastric 
tympany followed by recovery.! It is noticed also by 
Messrs. E. Wallis Hoare, Cork?; John Young, Edin- 
burgh®; and R. Shaw Craig.4 These writers all 
distinctly recognise this condition of distended stomach. 

Causes.—As is the rule with cases of equine colic, we 
may confidently look to dietetic errors as the main factor 
in the causation of this complaint. Those in country 
practice may expect the bulk of their cases from the hasty 
bolting of a quantity of young and succulent herbage, 
particularly clover, growing corn, lucerne, or vetches. 
Other cases will occasionally crop up where the animals 
have been allowed a large quantity of mixed ground 
corn. These attacks are frequent, too, in localities 
where animals are turned, fresh from a winter’s stabling, 
on to a field of young spring grass, more especially if the 
pasture be marshy. 

In some districts it is customary, immediately after 
harvest, to put by a number of unthreshed oat-sheaves, 
which are cut up and used as chaff, with or without the 
admixture of other seasoned hay. This, again, is a cause 
of numbers of cases of tympanitic stomach. The same 
may be said of newly-threshed oats. 

Where such palpable causes as these are absent the 
practitioner must look with suspicion upon food that has 
been badly harvested—mow-burnt hay and mouldy corn. 
Personally, Iam not an advocate for the use of boiled 
foods, and look upon them as a frequent cause of colic 
troubles. Such foods, unless the men are well superin- 
tended and the supplies kept fresh, will turn sour and 
inevitably give rise to fermentation when eaten. For the 


1 Veterinary Journal, vol. ii., p. 174. 
2 Veterinarian, vol. |xix., p. 794. 3 Jbid., vol. xlviii., Pp. 593. 
¢ Veterinary Record, vol, ix., p. 214. 


GASTRIC TYMPANY 55 


same reason the use of steeped barley or wheat is not to 
be advised, while wheat or barley in the unsteeped form 
may be looked upon as a poison. 7 

This same complaint, though not in an acute form, 
may be occasioned by the vicious habit of crib-biting ; 
the stomach and abdomen become visibly distended, colic 
pains following closely after. 

Greedy feeding and imperfect mastication of food may 
also be put down as acause. In Mr. Broad’s case he 
distinctly states that it was the hasty swallowing of oats 
in an unmasticated state which produced indigestion, 
this giving rise to tympanites of the stomach and intes- 
tines. Mr. Broad also relates another case in which the 
most serious tympanites resulted from the eating of 
‘cinquefoil.’ 

Other and rarer causes may occasionally be found in 
some diseased state of the stomach, giving rise, in the 
first place, to indigestion, and, secondly, to fermentation 
of its contents—e.g., the ulcerative condition occasioned 
by the presence of large numbers of bots, gastric calcul, 
etc. 

General F’. Smith, in dealing with this disorder, quotes 
from the pen of Mr. Gillespie to illustrate the dangers 
of mouldy food! I cannot do better than repeat it 
here. 

‘On a certain morning I was called to see some horses 
of the 5th Punjab Cavalry in camp, and on arriving at 
the lines, about 250 yards off, found several horses dead, 
and others apparently dying fast, and all extremely tym- 
panitic. Either three or four had died during the night, 
and five or six more had been attacked, but some so 
slightly as to be fit to go to the lines after exercise. 


1 Proceedings of the Fifth General Meeting of the National 
Veterinary Association, p. 79. 


56 THE COMMON COLICS OF THE HORSE 


‘I remember that one, when about to receive an enema, 
went down, and I thought it was all over with him, for 
he looked more dead than alive. However, to my great 
surprise, he showed a desire to get up, and, once on his 
feet, he was kept trotting until his bowels began to act, 
and he was saved. I think this was the only bad case that 
recovered, I blamed the grass at once, and got a sample, 
which, from mouldiness, was truly enough to set up any 
amount of fermentation in the internal economy; and 
be it known tympany was the sole cause of all this 
mischief. 

‘I attended the post-mortem of all those that had died, 
and no sooner were the abdominal walls severed than the 
stomach, and sometimes the colon, exploded with con- 
siderable noise, scattering the contents for many yards 
around. 

‘In some instances there were traces of congestion of 
the mucous membrane of the intestines (not confined to 
any particular point), and in one case there was a leaden 
colour of part of the ileum. I looked upon the immediate 
cause of death as being suffocation. The pressure on the 
walls of the stomach must have been enormous, for it 
split like a bubble, and so did the large intestine, but the 
latter only burst on a few occasions.’ 

Symptoms.—In most cases these will be fairly well 
pronounced before the arrival of the veterinary surgeon. 
Nevertheless, I must again warn the practitioner that the 
outset, even of a serious attack, may be comparatively 
simple. The horse is seized with colic pains soon after 
the offending feed. The pulse at first is but little 
quickened, and the respirations are not increased to any 
marked extent. Asa consequence, the animal is treated 
in the usual way by the attendants before calling in skilled 
advice, 


GASTRIC TYMPANY 57 


During this time the patient has been gradually getting 
worse, the pains have become more severe, and the 
tympany more marked. The owner eventually becomes 
alarmed, and the veterinarian is sent for. 

The symptoms now presented are of an excessively 
alarming ‘nature. The unfortunate animal is in a bath of 
perspiration ; his countenance is suggestive of the most 
agonizing torture; and, staggering blindly about, he is a 
danger to himself and those about him. His pains have 
rendered him unmanageable, and with the greatest diffi- 
culty can he be kept upon his legs. That is one state of 
affairs that meets the eye of the surgeon. 

In other cases a totally different set of symptoms will 
be presented for his inspection. Instead of madly flinging 
himself down, only to rise and rush in frenzy round his 
box, the poor brute stands in patient agony. He appears 
now to have some God-given instinct that violence will 
only render worse his well-nigh hopeless case. He occa. 
sionally makes quiet crouching attempts to lie, but stands 
for the most part quiet. The distressed nature of his 
respirations, however, and the pinched, haggard expres- 
sion of his countenance reveal the intensity of his suffer- 
ing, as, with appealing-looking eyes, he turns from one 
to the other of those standing by for help in his agony. 

In both cases examination reveals an alarming state of 
the pulse and respirations. The pulse, weak in character, 
is found to be hammering frantically at a rate of 100 to 
120 beats a minute, and the breathing, of a painful, gasp- 
ing, see-saw character, is accelerated from the normal to 
aS Many as 140 to I50. 

Oftentimes the abdomen is found to be tensely 
tympanitic; rarely, it will be found to be about the 
normal, no noticeable distension, and peristalsis evident 
on auscultation, In those cases where abdominal dis- 


58 THE COMMON COLICS OF THE HORSE | 


tension is marked, rectal exploration will sometimes 
reveal coils of distended intestines occupying the pelvis, 
and the operator’s arm is met with painful straining 
efforts on the part of the patient. At times the rectum 
is found to contain a few hard lumps. | 

Distension of the abdomen, however, is not a constant 
symptom. It is sometimes almost entirely absent, in 
which case what tympany there is will be seen on the 
left side and fairly well forward. My experience leads 
me to the conviction that those cases in which the bowels 
are free from tympany are the ones that yield most readily 
to treatment. 

When the case has occurred without previous feeding 
on green food, careful inquiries will elicit the fact that 
the passage of feeces has been fairly regular throughout 
the day, and that the pains only came on soon after 
partaking of a particular feed. The most striking and 
most diagnostic symptom is the frequent eructation of 
gas, and here one word of caution is necessary. I have 
called it ‘eructation,’ possibly giving my reader to under- 
stand that large volumes of gas are escaping by the 
cesophagus. I need hardly say that such is not the case, 
for, if that were happening, the animal would soon gain 
natural relief. In the great majority of instances the 
spasmodic contraction of the cervical muscles, the retch- 
ing noise emitted by the patient, and the gurgling noises 
in the cesophagus serve to relieve the patient no further 
than the expulsion of quite a small quantity of gas, and, 
at times, a thin trickling of ingesta from the nostrils. 

Should relief not soon be obtained, the symptoms 
become worse still, and quickly post onto the end. The 
breathing becomes more and more distressed; the 
abdomen fills further and further with gas, and the 
small quantity of fluid ejected from the nostrils increases 


GASTRIC TYMPANY 59 


in volume until it becomes a disgusting vomit. Saliva 
hangs in strings from the muzzle; the gurgling noise in 
the cesophagus becomes louder and more frequent, and is 
further augmented by the rattling of fluid ingesta that 
has gained entrance to the trachea; patchy perspirations 
bedew the body, and the whole appearance is indicative 
of the greatest concern and anxiety. 

Later, the animal becomes pulseless, delirium comes 
on, and he staggers unconsciously round and round 
his box. 

‘Doing the Dead March!’ mutters the veterinarian to 
himself, turning aside to hide his vexation. 

Shortly afterwards the poor brute expires in convul- 
sions, in his agony clutching the ground with his teeth, 
as he draws his final gasps. The eyes recede, the limbs 
stiffen, and the patient slave has finished his toil. 

Diagnosis.— When the case is fairly well advanced 
this should offer no great amount of difficulty. As I 
have stated before, attacks of tympanitic stomach are 
somewhat deceiving at the outset, and the very mildness 
of the early symptoms may lead the veterinarian to look 
too lightly upon his case. At the most, however, from 
one to two hours will produce unequivocal symptoms, 
and the veterinary surgeon is able, with all confidence, 
to set about treating the case. 

The manner in which the diagnosis may be proceeded 
with is something after this fashion: The veterinarian 
finds his patient so frantic with pain, so bedewed with 
sweat, and his pulse so quickened as to immediately 
suggest that dire disease ‘enteritis.’ He is relieved on 
that score by an examination of the conjunctiva. It is 
not of that ‘ raw-beef’ redness so invariably associated 
with that fell malady. The respiration to his practised 
ear suggests, in addition to pain, something of suffocating 


60 THE COMMON COLICS OF THE HORSE ~ 


pressure on the diaphragm. While engaged in this, the 
examiner will often hear sounds of peristalsis, with some- 
times the passing of a small volume of flatus fey anum. 
He knows, again, that in enteritis these movements and 
sounds are almost always entirely absent. The eye, 
though expressive of excruciating pain, has not the 
haggard ‘I’m done for’ kind of expression that the 
animal in the fatal grip of enteritis always shows. 

Having dismissed enteritis from his calculations, the 
field of error is considerably reduced. The pains are not 
those of ordinary impaction of the stomach or intestines ; 
they are much too acute in character. Is it twist, 
volvulus, or strangulated hernia? In a typical case of 
the affection even these serious-sounding suggestions are 
easily disposed of. ‘The abdomen is not hard enough, 
tense enough, tympanitic enough to allow of such an idea 
being seriously entertained for long. It will not be for- 
gotten, however, that, as previously stated, the abdomen 
may be tympanitic, so that, to assist him in his diagnosis, 
the veterinarian must look for signs more convincing still 
ere he comes to a final conclusion. 

Perhaps he has punctured the abdomen, and still finds 
tympany remaining. In the positions in which he has 
operated he knows he should have encountered the 
cecum and colon. He knows of no other bowel that is 
able to distend to the extent that his case presents. He 
is compelled, and rightly, to fall back on the stomach as 
the seat of mischief. 

He is struck by the catchy, see-saw breathing, and the 
trickling fluid, small in quantity, running from the 
nostrils. He auscultates the trachea, and obtains distinct 
evidence of fluid in that passage. ‘The idea of an inspired 
drench is emphatically negatived by the owner and 
attendants; sometimes, even, one has not been ad. 


GASTRIC TYMPANY 61 


ministered. The balance of evidence, even now inclining 
heavily towards ‘stomach trouble,’ is weightily dropped 
by the exhibition of a definite and characteristic set of 
symptoms on the part of the patient. There is an 
entirely involuntary regurgitation of the cesophagus, with 
a peculiar gurgling, bubbling noise in the chest, as, with 
a suppressed squeal of pain, and a slight depression of 
the head, the animal exudes a small quantity of ingesta- 
stained fluid from the nostrils. 

The veterinary surgeon knows now he has a case of 
tympanitic stomach, and that a bad one, on his hands. 
Should it happen, however, that he is only partly con- 
vinced, he will be made more certain still by closely 
watching the animal’s movements. The act of lying 
down is performed with care, and, should his case 
fortunately be uncomplicated by intestinal tympany, 
he will notice distinct signs of tympany right forward, 
under the last rib, on the left side. In addition to this, 
some practitioners have observed that the perspiration 
is confined to the left side, or more pronounced over 
the region of the stomach. I cannot say that I have 
noticed it. 

One other symptom, and that a fairly diagnostic one, 
still remains. When down, the animal sometimes raises 
himself on his fore-feet, and sits, dog-like, on his 
haunches. Mr. Broad of Bath has declared that to be 
almost, if not quite, diagnostic of stomach affection. He 
Says; ‘Sitting on the haunches has its diagnostic value; 
it indicates the seat and nature of the pain evinced—that 
is, Overdistension of the stomach and anterior part of 
colon, or both—the horse taking this position to relieve 
the diaphragm of their weight and pressure.’ 

With a set of symptoms like the above the veterinary 
surgeon should have no great difficulty in summing up 


62 THE COMMON COLICS OF THE HORSE 


his case. Even should only one-half of them be exhibited, ~ 
a right understanding should be arrived at. 

There is another, and more grave condition, however, 
which may so-closely simulate tympanitic stomach as to 
lead to serious error. I refer to twist of the double 
colon, at either its sternal or diaphragmatic flexure, or 
both. It is in the elimination of this possibility that the 
greatest difficulty in the way of a correct diagnosis lies. 
An animal in which that condition is present will, during 
the first pains arising from it, exhibit signs that even 
the most skilled may be excused for confounding with 
flatulent stomach. There is the same quick pulse, 80 to 
go, or 120; the same catchy, see-saw breathing; the 
same signs of attempted eructation, and the same ingesta- 
stained fluid running from the nose. Everything seems 
in order, and the case is treated, as its symptoms appear 
to warrant, for gastric tympany. 

Six to eight hours elapse, and the practitioner pays 
another visit. He finds the symptoms no whit abated, 
and recognises the case is a dangerous one. Even on 
his first visit he had been struck by the intense redness 
of the conjunctiva. This has increased now to a condi- 
tion resembling that seen in the disease known as 
enteritis, and the pulse has grown weaker and faster than 
before. Still—and this is the circumstance that leads 
first to wonder, and then to an alteration in the diagnosis 
—the animal spends a great deal of his time in a re- 
cumbent position. Reared upon his chest, he lies in 
apparent half-comfort. Were it not for the redness of 
the conjunctiva, and the peculiar catching sob that is now 
taking place with each respiration, his position would 
indicate ease. In other words, his pains, on a first 
glance, would come under the category of ‘ dull,’ and be 
thus correctly referred to the colon. 


GASTRIC TYMPANY 63 


But why the stomach symptoms? They are there in 
alarming abundance, and the practitioner feels bound to 
treat them. 

The third and fourth visits find the same symptoms 
present, but the animal visibly weaker. Twenty-four to 
forty-eight hours sees the end. 

While writing this I have a case in my mind which 
_ran an exactly similar course to the one described above. 
It was treated for gastric tympany, and its real nature 
unsuspected until the expiration of twelve to twenty-four 
hours. It was then apparent that some serious condition 
was impeding the egress of food from the duodenal end 
of the stomach, and the possibility of the presence of 
twist was suggested to the owner. It was even ventured 
to locate the seat of twist as the duodenum. The end 
of the second day saw the death of the animal, and 
a post-mortem examination cleared things up satisfac- 
torily. 

The double colon was twisted two or three times upon 
itself in the position of the sternal and diaphragmatic 
flexures, thus completely shutting off the second and 
third portions of the bowel from the first and fourth. 

In that portion of the bowel immediately anterior to 
the twist was a huge mass of accumulated ingesta. This 
was lying in close apposition with and pressing on the 
stomach, accounting to some extent, no doubt, for the 
preponderance of stomach symptoms that presented so 
perplexing a part of the history of the case. 

It will be seen from this that the utmost care is 
necessary when giving a diagnosis of, or foretelling the 
issue of, a case of tympanitic stomach. In the majority 
of cases the symptoms I have described will lead the 
practitioner to a correct estimate of his patient’s con- 
dition. He should never forget, however, the possibility 


64 THE COMMON COLICS OF THE HORSE 


of twisted colon, and should take care that his examination 
of the sufferer is a long and searching one. 

The only signs that will serve to distinguish the two 
complaints are the following: The palpable stomach 
symptoms must be laid aside for the minute, and a great 
deal of reliance placed upon the one symptom ef the 
animal’s desire to lie about for lengthy periods. Ina 
typical case of tympanitic stomach that does not occur. 
The respirations, in addition to being catchy and see-saw 
in their character, are added to by a plain and unmis- 
takable sob—not a gasp for breath owing to pressure on 
the lungs, but a sob of pain. Finally, the gradual in- 
crease of the conjunctival mucous membranes in redness 
and the fatal indications afforded by the quickened and 
fastly weakening pulse will lead one, a few hours after the 
commencement of the attack, to a knowledge of its true 
nature. 

Prognosis.—It may be said that all cases of tym- 
panitic stomach, especially when the tympany is of such 
an extent as to be easily diagnosed, offer a grave element 
of danger. Anatomical reasons, already discussed in 
Chapter II., warrant one in that statement. When the 
tympany of the stomach is accompanied with impacted 
or tympanitic intestines, it is always wise to warn the 
owner that the case may have a fatal termination. When 
the tympany is confined to the stomach, the abdomen 
fairly flaccid, and the bowels acting, a more favourable 
issue may with safety be prophesied, always reserving 
the promise by indicating the likely finish, should tympany 
of the intestines supervene. A further reservation will 
also have to be made in the very early stages of the case 
when allowing for the condition of twisted colon. The 
owner may safely be advised that a few hours will settle 
the question. Either his case of stomach tympany, 


GASTRIC TYMPANY 65 


under suitable treatment, will begin to mend, or the fatal 
and unequivocal signs of twist be in evidence. 

Again, it is always policy, when dealing with a case of 

this description, to point out the probability of rupture 
occurring. The veterinarian may, with all justice, inform 
his client that vomiting is not necessarily a sign that such 
has already taken place. It is impossible to diagnose 
this lesion until its fatal signs are present (see 
Chapter VIII.), and the veterinary surgeon may con- 
fidently proceed to treat his case, promising to advise 
his client immediately symptoms of an alarming nature 
present themselves. 
- Treatment.—This offers to the veterinarian one or two. 
interesting little problems. Primarily, the lines upon 
which he may start and upon which his treatment must 
be based are simple indeed. They may be succinctly 
summed up in these two immediate instructions: (1) Rid 
the stomach of gas already present. (2) Prevent the 
formation of any more. 

Before attempting to dispose of the gases, it is neces- 
sary to know their composition. Recent experiments 
have shown that those which bulk most largely in the dis- 
tended stomach are carbonic acid, carburetted hydrogen, 
sulphuretted hydrogen, and nitrogen, the nitrogen form- 
ing only a small proportion. As carburetted hydrogen 
cannot conveniently be absorbed by any vehicle which 
may be administered fey ovem, our remedial agents 
must be mainly directed against carbonic acid and 
sulphuretted hydrogen. We are again compelled to 
fall back upon what may be regarded as the veterinary 
surgeon’s sheet-anchor in the treatment of the equine 
colics—ammonia. In this case, however, the success of 
the treatment will entirely depend upon what form of 
ammonia is used. 

b 


66 THE COMMON COLICS OF THE HORSE 


In this particular instance the use of the carbonate 
would be well-nigh fatal: and this is the reason. We 
may safely assume with a tympanitic stomach that we 
have an acid condition of its contents. That being so, 
the administered carbonate would, by the action on it of 
the acid, be caused to evolve carbonic acid, and add still 

further to the volume of that gas already in the stomach. 
The form of ammonia indicated is the solution of 
ammonium hydrate (the liquor ammoniz fort. of the 
pharmacopceias), because by its exhibition the carbonic 
acid gas present in the stomach will readily be absorbed 
(to form ammonium carbonate), while, with a suitable 
addition (as, for example, iron or bismuth) the sul- 
phuretted hydrogen may also be combined, and caused 
to leave its gaseous form, thus greatly lessening the 
volume of gases in the stomach. Such an admixture is 
easily prepared as follows: 


Ferri sulph. pulv. - - ° : 5l. 
Aqua (fervens)_ - > - . Oil. 
Liq. ammon. fort. . . +. Bie? 


This mixture, with its resulting precipitate, should be 
administered at once. The freshly precipitated hydrate 
of iron combines with the sulphuretted hydrogen, while’ 
the free ammonia, still exerting its stimulant and anti- 
spasmodic actions, absorbs the carbonic acid. 

This is the treatment I would recommend as the most 
suitable for disposing of the accumulated stomach gases. 
This done, it is wise to follow on with the exhibition of 
some form of mild antiseptic, one with stimulant pro- 

1 One word is necessary in order to explain the apparently 
excessive dose of liq. ammon. fort. An estimated 3 drachms of 
that goes to the formation of hydrate of iron, thus leaving really 
only 1 drachm of free ammonia for stimulant and antispasmodic 
purposes.—H, C, R. 


GASTRIC TYMPANY 67 


perties preferred—e.g., terebene, ol. tereb., or water 
strongly impregnated with ol. menth. pip. Either of 
these will tend to stay the fermentation going on in the 
stomach, and render the evolving of further gas from the 
mass unlikely. 

It is usual with most practitioners to combine with the 
ammonia a carminative and sedative; also to administer 
at the same time an aloetic purgative. As fair samples 
of the many drenches so given, I select the following: 


1, Tinct. opii . el 2. Terebene pur. - SS pyle 
Spt. ammon., ar. - 5i. Chlorodyne - - 35iv. 
Ether sulph. - = Ove ope.-eth, mit, © = - $i. 
Aloes sol, - wiet = Bvin Ol. lini - 2 - Oiss. 
Ol. lini - . - Oss, 


These two drenches are both open to serious objection, 
No. 1 more so than No. 2. In No.1 the only medicine 
at all calculated to act on the stomachic gases is the spt. 
ammon. ar. The amount of free ammonia in that pre- 
paration, however, is not enough to work any beneficial 
result unless given in far greater doses than there laid 
down, while, if given in large doses, its greater proportion 
of contained ammonium carbonate will act adversely, as 
before described. 

Drench No. 2 offers us a useful antiseptic in the form 
of terebene. ‘This, in all probability, will prevent the 
formation of any further gas than that already in the 
stomach. That it will effectually dispose of the volume 
already there, and so relieve the distended stomach, is, to 
say the least of it, highly problematical. 

In these draughts the ingredients to which I take 
serious exception are the opium and the chlorodyne with 
its contained morphia and mixture of other and various 
sedatives. I most strongly advise all and everyone to 


avoid, as they would avoid poison, giving sedatives to the 
[2 


68 THE COMMON COLICS OF THE HORSE 


horse with colic—what form of colic matters but little, 
unless accompanied with violent purging. 

By all means adopt any other part you wish of the 
treatment here laid down. Give aloes, even, if you are 
so inclined, though that is useless and unnecessary. But 
if you earnestly wish your list of successful cases to 
increase, if you wish to give satisfaction to yourself and 
to your client, give the widest possible berth to sedatives. 
Leave them severely alone. My reasons for this advice 
will be found more fully stated in the chapter on Intestinal 
Impaction. 

Applying this advice to the disorder we are now dis- 
cussing, we shall find the explanation simple enough, thus: 

We have a horse with hus stomach enormously distended with 
gas. In all probability tts distension 1s materially assisting 
in the closuve of the duodenal trap (see Chapter II., Figs. 2 
and 3) by the mere force of pressure. We have already shown 
(Chapter IV., p. 28) that the horse 1s anatomically unable to 
adequately velieve himself by way of the esophagus. Ergo, 
the only natural velief we can possibly hope for 1s the unlocking 
of the duodenal trap by violent and energetic intestinal movements. 
And these movements the practitioner proposes to altogether 
vestvict by administering a dose of opium. ... Not only is 
that unveasonable—tt is criminal. Weve our patient a human 
being it would be considered, and nghtly considered, slaughter. 

It is no mere fad of mine, this wholesale condemnation 
of the use of sedatives in equine colic. It is the outcome 
of many an unconscious experiment, the fruit of much 
bitter experience, and the careful weighing together of 
the data so obtained. I would ask all who seriously read 
my little volume to give the most weighty and thought- 
ful consideration to the paragraph immediately preceding 
this. ‘The matter it contains is small in bulk, but offers 
much food for quiet reflection. 


GASTRIC TYMPANY 69 


I have said that the only possible natural means of 
relief we can hope for is the unlocking of the duodenal 
trap by violent and energetic intestinal movements. 
Nature may be assisted in bringing that happy state of 
affairs about, and it is the veterinary surgeon’s manifest 
duty to so assist her by giving his patient a dose of 
eserine and pilocarpine, or any other drug that will 
stimulate the involuntary muscle of the intestines into 
immediate action. For my own part, in whatever way I 
have treated the stomach gases by fey ovem remedies, I 
have always administered with the happiest results a 
simple hypodermic dose of eserine sulphate (2 grains 
to 24 grains). When it acts, it is surprising to note, 
although the abdomen is previously not tympanitic, the 
immense volumes of flatus that are passed fey anum. 
After only an hour’s severe pain, its effect is complete 
and lasting relief. As illustrative of its beneficial action, 
I will quote the following case occurring in my own 
practice, 

September 16, 11 p.m.—I was called to a farm 6 miles 
distant to attend a heavy cart mare. The following 
history of the case was quickly obtained. The patient 
had left the stable at 6.45 a.m. in her usual good health, 
had been at plough all day, and was returned to the 
stable at 3.45 p.m., and given a full feed of chopped new 
oat straw and Indian corn. Immediately after this she 
was put to work at a circular chaff-cutting machine, 
following upon which she was quickly taken ill. I found 
the poor brute in agonies of pain (far too bad to roll), 
pulse 120, respirations enormously quickened, and of a 
gasping see-saw nature, and a temperature of 103° F., 
The rectum contained a few hard lumps and was non- 
contracting; there was no abdominal distension; the 
other bowels were fairly empty, and auscultation gave 


70 THE COMMON COLICS OF THE HORSE 


slight evidence of peristalsis. With each respiration 
there was a peculiar forward movement of the cesophagus, 
with, every now and again, distinct sounds of attempted 
eructation. ‘There was no ingesta returning through the 
nostrils, and yet auscultation of the trachea revealed 
sounds of fluid in that passage. Inquiries elicited the 
fact that the animal was choked with the drinks 
administered before my arrival. 

I diagnosed tympanitic stomach, with inability of the 
pylorus to pass it. Having administered the usual 
remedies, I resolved to at once empty the intestines, for, 
seeing that I had already obtained slight evidence of 
peristalsis, | apprehended no difficulty in so doing. To 
that end 1 administered a full dose of eserine sulphate 
(24 grains hypodermically), and prepared myself to watch 
results. 

September 17, 12.30 a.m.—The end of half an hour saw 
full and frequent passage of tremendous volumes of flatus 
per anum, and by this time the mare was distinctly 
relieved, though still blowing hard from the effects of the 
inspired drenches. The attempts at eructation were far 
less frequent, and I saw that I had now overcome the 
stomach trouble. I gave a guarded prognosis, however, 
not knowing how the tracheal disturbance was likely 
to end. 

September 17, 10.30 a.m.—Mare picking at provender. 
Entirely free from colic pains, but causing grave anxiety 
on account of the pulmonary congestion. ‘The usual 
remedies were administered, and, though ailing some 
days, the animal made an uninterrupted recovery. 

I have now laid down a simple and rational treatment 
for combating this distressing disorder. Before closing 
the chapter, however, it is my duty to mention two other 
means which are sometimes discussed, but seldom or 


i a CE i 


GASTRIC TYMPANY 71 


never practised. I am referring to the use of a trocar 
and cannula on the stomach, and the passing of an 
cesophagus-tube. | 

I think that most veterinarians will 
agree with me in saying that puncturing 
the stomach is not without a grave ele- 
ment of danger, and therefore not to be 
advised. However, should tympany of 
the intestine also be present, the opera- 
tion of puncturing the bowels should be 
the first consideration. It is simple, 
unattended with serious risk, and imme- 
diately effectual in affording instant 
relief. 

The use of the cesophagus - tube 
is hardly likely to come into vogue. 
It was first suggested by Percivall, 
and afterwards advocated by General 
Smith. That it would afford relief if 
introduced no one would attempt to 
deny. As General Smith’s writings, 
however, so far as I can trace them, 
leave the instrument yet ‘imperfect,’ 
the veterinary surgeon must either ex- 
periment in that line himself, or wait 
until someone has further improved upon 
this mechanical means of treatment.} 


1 Since the above was written I have received 
letters from two American practitioners, the oe ZAR ee sh 
contents of which are at any rate interesting in  Srowacu-TusE. 
this connection. I give them here: 

Dr, A. T. Everett, of South Omaha, Nebraska, to whom I am 
_indebted for Fig. 7, says: ‘ With reference to the cesophagus-tube, 
which you say is as yet ‘‘imperfect,’’ I enclose you a cut of a 
stomach-tube invented by Mr. D. O. Knisely, which seems to give 


72 THE COMMON COLICS OF THE HORSE 


It is not lhkely to be adopted by the average prac- 
titioner as a principal line in his treatment, for these 
reasons: It is rather cumbersome, adds to his impedi- 
menta, and can only be required in quite a small 
percentage of the cases of ‘colic’ he is called upon to 
attend. Whatever treatment the practitioner has decided 
to adopt, let him carefully remember one detail of the 
utmost importance. When he has with certainty 
diagnosed tympany of the stomach, it is his duty to 
emphatically warn the owner and attendants of the 
danger the horse runs if allowed to roll. It is extremely 
likely. to bring about the lesion I describe in my next 
chapter, rupture of the stomach. : 


excellent results in the hands of several veterinarians who have used 
one. ‘The single tubes are practically useless, as they block up with 
food ; and a man using one throws it away in disgust. With this 
you do not experience this trouble.’ 

This tube here illustrated is 10 feet in length, is double for 7 feet, 
and has the balance in separate tubes. 

The double part has the tube cemented together, so as to make 
the outside circumference small enough to be readily passed through 
the cesophagus into the stomach. The large opening is } inch 
across, and is the outlet from the stomach through which the 
food and the gases will return. The smaller opening is } inch 
in diameter, through which water is passed into the stomach. This 
latter procedure is presumably to aid the egress of the food through 
the larger tube. 

Dr. T. B. Rogers, of Woodbury, New Jersey, says: ‘ With regard 
to the passing of the stomach-tube, this is nowastandard procedure 
with our more scientific practitioners, and if you wet the tube and 
roll it in powdered, slippery elm-bark, instead of greasing it, pass it 
slowly, waiting for the efforts at deglutition its passage excites, the 
operation presents no difficulty.’ 

It would seem from this that the cesophagus- pate which with 
English practitioners has remained in the experimental stage, has 
in America been improved on to the extent of being rendered 
a useful agent in affording relief in both gastric tympany and 
gastric engorgement, 


CHAPTER VIII 


RUPTURE OF THE STOMACH: GASTRO- 
RHEXIS 


Definition.—A breach or disruption, complete or in- 
complete, of the tunics forming the walls of the stomach, 
with consequent escape of the contents of the organ. 
Causes.—Principally we may regard this lesion as 
a direct result of the disorder considered in the 
previous chapter, the mere mechanical pressure of 
the accumulated gases being sufficient to bring it 
about. More for that reason than that it offers any 
particular medical problem have I seen fit to insert 
its description here. Rupture may also result from 
ordinary impacted or gorged stomach (Chapter VI.), 
though it is well to add that cases following upon 
that condition are not nearly so many in number 
as those succeeding acute gastric tympany. It will 
naturally follow that those causes enumerated as giving 
rise to tympanitic stomach might be again stated here as 
indirect factors in the production of gastric rupture, 
laying special stress on the overfeeding with young 
green stuffs, and the excessive use of boiled or steeped 
foods, with a period of work immediately on the full 
stomach. What I have already advised under that 
heading will bear repeating here: ‘Never allow the 


74 THE COMMON COLICS OF THE HORSE 


horse with a tympanitic stomach to indulge in rolling.’ 
There can be no doubt whatever that the violent strains 
and falls the frantic animal inflicts upon himself when in 
the paroxysms of acute gastric tympany are directly 
accountable for many of our cases of rupture. 

Cases are also on record where rupture of the stomach 
hhas been accompanied with, and no doubt preceded by, 
a thinned and ulcerated condition of the stomach walls, 
occasioned by the presence of large numbers of bots 
(CEstvus equt), giving rise, in the first place, to imperfect 
digestion of food, with its concomitant process of fermen- 
tation, resulting in tympany and pressure. 

Sometimes a sudden heavy fall is responsible for the 
lesion. Mr. Broad instances that as follows: ‘An aged 
horse, in a very weak condition, fell while at work, and 
was with difficulty made to rise. He again fell on 
reaching a stable close by, and died almost imme- 
diately. The coats of the stomach were attenuated and 
ruptured; * 

Other and rarer causes of this lesion may be found in 
the atrophy of the stomach walls produced by the vice of 
crib-biting, or in the ravages produced by the Sfivoptera 
megastoma.” 

I shall not concern myself here with a consideration of 
the nature and size of the rupture, nor its position or 
pathological appearances. Our interests will be mainly 
confined to its relation to colic, and the way in which it 
affects our diagnosis of the various disorders we are dis- 
cussing. It is, therefore, from that standpoint that I 
shall conclude this chapter. 

Symptoms.—I have already indicated that this lesion 

1 Veterinary Journal, vol. ii., p. 178. 


2 Proceedings of the Fifth General Meeting of the National 
Veterinary Association (Smith), 


RUPTURE OF THE STOMACH 75 


may occur with the stomach wall in one of two con- 
ditions. Either the tunics are in a state of health, or 
they are suffering from the ulcerated and atrophied 
condition occasioned by the inroads of parasites. 

We may take it from this that when the stomach walls 
are weakened by previous disease, an attack cf simple 
colic may be quite sufficient to bring about the rupture. 
In the paroxysms of pain the animal flings himself 
violently to the ground, and the mischief is done; in 
which instance the case, though finally diagnosed as 
ruptured stomach, is primarily looked upon as simple in 
its nature, owing to the regularly intermittent character 
of the pains. It is, in fact, first put down as, what it 
really is, a simple attack of colic, the rupture occurring 
afterwards. At times in his career every practitioner is 
bound to make that—I was almost calling it ‘ mis- 
take.’ He knows himself that it was a correct statement 
of the case as it first presented itself to him. When 
rupture suddenly changes his case from a simple to a 
fatal nature, it depends entirely upon his standing with 
his client and his amount of ready tact whether the 
veterinarian retires from the situation in ignominy or 
emerges therefrom with credit. I have not much hesita- 
tion myself in declaring this to be one of the vave causes 
of this lesion. Nevertheless, it occurs with sufficient 
frequency to confound our carefully-laid prognosis in 
other cases. 

In those instances where the rupture is primarily pro- 
duced by previous enormous tympany, the pains, almost 
from the very outset of the case, are agonizing and 
continuous. 

Our case of ruptured stomach, then, may be ushered 
in with either intermittent or continuous pain. Once 
established, however, rupture of the stomach offers 


76 THE COMMON COLICS OF THE HORSE 


symptoms only too painfully diagnostic in their 
character. 

Diagnosis. —‘ There exist two cogent reasons for 
wishing to be able to pronounce at once upon a case of 
ruptured stomach: the first is, the preservation, if not 
enhancement, of the medical attendant’s reputation ; the 
.second, the saving of solicitude on his part, and the 
annoyance on the part of his patient, of administering 
anything under such hopeless circumstances.’! 

Difficult to describe, it is the character of the pulse 
that gives the experienced veterinarian his first warning 
of the fatal nature of his case. During the early stages— 
that is, before rupture has occurred—the pulse is full and 
firm in its beats; contracted to a thread only during the 
paroxysms of colic; again becoming full and bounding 
in the intervals of comparative ease. With the appear- 
ance of rupture its whole character is altered, and it grows 
small, frightfully quick, and as frequent as 90 to 120. I 
cannot better describe ‘small’ than by saying it is that 
kind of pulse the novice has difficulty in detecting at 
all—the vessel is not fully distended. The respirations 
become accelerated, and the conjunctiva slightly injected. 
The pains increase in violence, and the patient becomes 
almost ungovernable. Later, the unfortunate animal is 
bathed in sweat, trickling in drops down the face, running 
down the mane, coursing in streams down the inside of 
the arms and thighs, and splashing in drops from the 
belly. Violent tremors shake the body, the tail is out- 
stretched and quivering, and the extremities are deathly 
cold. The hand that takes the pulse in the brachial 
region is withdrawn with a shudder ; the signs conveyed 
to it lead to an almost instinctive dread, a significant 
intuition of fast coming dissolution. 


1 Percivall’s ‘ Hippopathology,’ vol. ii., p. 24. 


RUPTURE OF THE STOMACH 77 


The patient may now sit for several minutes at a time 
on his haunches, or, as is more general, may stand 
quietly, giving the uninitiated the appearance of greater 
ease. His countenance, however, is still indicative of 
his condition. It is almost ‘sardonic’ in the expression 
it conveys. The ears droop, the angles of the mouth are 
retracted, and the teeth protrude in a ghastly grin. 

It is now that the vomiting —the much -discussed 
vomiting—begins to occur. Every now and again the 
duid-like ingesta of the stomach is ejected with or with- 
out symptoms of vomiting on the part of the patient, and 
the administration of medicines only tends to aggravate 
his suffering. In some cases the emesis is but an in- 
voluntary, though constant, dribble from the nostrils; 
in others it is an act of distinct and painful retching, 
accompanied with all the equine phenomena of vomiting. 
One other symptom there is which, if only constant, 
would lead to diagnosis always being absolute. I refer 
to the escaped ingesta being detected in the peritoneal 
cavity when exploring peyv vectum. It is unfortunate 
that this evidence is not constantly obtainable. 

The pulse now becomes more and more imperceptible, 
the muscular tremors increase in severity, the breathing is 
a shivering sob, and the legs are propped out wide apart 
to keep the unfortunate animal from falling. When he 
drops it is all over, for a very few seconds then ends the 
scene, and the poor brute usually expires with the ingesta 

gushing in streams through his nostrils. 
_ These symptoms are the ones that may fairly be taken 
as diagnostic—that is, as far as we are able to diagnose 
this affection. They will lead to a correct diagnosis in 
the majority of instances, In addition to the signs here 
given, however, the young practitioner must remember 
that all the usual symptoms of ‘ colic,’ as described in 


78 THE COMMON COLICS OF THE HORSE 


other chapters (Tympanitic Stomach, for instance), may 
be shown in gastric rupture. 

The reader will have gathered from the foregoing that 
we have no really diagnostic symptoms of ruptured 
stomach. General F. Smith sums the matter up thus: 
‘Diagnosis of this affection is anything but easy; we 
- have no diagnostic symptoms, and no two cases of this lesion 
present the same appearances, I think the symptoms 
on which we can place the most reliance are: paroxysms 
after the administration of medicines, extreme anxiety of 
countenance, in some cases the presence of particles of 
ingesta in the peritoneal sac detectable on exploration 
perv vectum, running down pulse, cold sweats and rigors, 
with coldness of the surface; and should vomiting and 
sitting on the haunches occur in conjunction with these, 
it only strengthens the diagnosis, but theiy absence in no 
wise weakens it.’ | 

Prognosis.—Once positively diagnosed, the case, of 
course, is hopeless. ‘The question the veterinarian is 
most likely to ask, however, is this: ‘ What dependence 
am I to place on the symptom of vomiting? When 
vomiting occurs, am I to positively declare my case one 
of rupture?’ Owing to this vomiting question being a 
much vexed one, several facts stand out with greater 
distinctness than they otherwise would have done. For 
instance, it is certain— 

1. That cases of rupture occur in which vomiting is a 
most marked symptom. 

2. That cases of rupture occur in which vomition is 
altogether absent. 

3. That cases of vomiting occur, followed by ae 
recovery, from which we may reasonably infer that 
there was no rupture. 

It follows from this that vomition is not absolutely 


RUPTURE OF THE STOMACH 79 


diagnostic of rupture. It is only fair to add, however, 
that it is so frequently an accompaniment of that lesion 
as to render it of great value when summing up our case. 
Even when vomiting is present in alarming degree, it is 
the veterinary surgeon’s duty to persist in treating his 
case for gastric engorgement, gastric tympany, or 
whatever he may have decided it is, reserving all his 
statements by saying ‘that it is just possible rupture 
may occur,’ and declining to advise his client of the 
advent of rupture until all or most of its absolutely fatal 
signs are present. ‘Taken singly, there are no diagnostic 
symptoms of ruptured stomach. Collectively, however, 
the evidence obtained from the patient should, in most 
cases, allow of a prognosis being given. Needless to 
say, it is a fatal one. 

Treatment.—Beyond prophylaxis, the treatment of 
ruptured stomach is out of all question. Means for its 
prevention, however, may be discussed with advantage. 
Nevertheless, it is not my intention to enlarge on them 
here. They are so largely dependent on common-sense 
reasoning, deduced from the causes of other stomach 
troubles, that it would be but tedious repetition on my 
part to mention them in detail again. 

We may take it that the reader of this volume will 
gather sufficient information from the chapters on The 
Predisposing Causes of Colic, Gastric Impaction, and 
Gastric Tympany to enable him to appropriately point 
out the suitable preventive measures likely to guard 
against the occurrence of this most distressing and fatal 
lesion. 


CHAPTER 


SUBACUTE OBSTRUCTION OF THE 
DOUBLE COLON: IMPACTION OF 
THE INTESTINES, IMPACTION OF 
THE COLON, STOPPAGE OF THE 
BOWELS 


Definition. — Intestinal impaction or obstruction, if 
loosely used, is a term which will cover a multitude of 
widely differing disorders, and I cannot help but think 
that the time is now ripe for an attempt to separate 
a few of them from their confusing surroundings, and 
essay to consider them singly. [ am not without hope 
that in so doing a more dependable knowledge of their 
peculiarities will be gathered—a knowledge which must 
inevitably lead to a more correct diagnosis, and a cor- 
responding improvement in the particular line of treat- 
ment adopted for each. To further that end I have, 
somewhat arbitrarily, I admit, and yet not without a due 
amount of just reason for so doing, divided the subacute 
intestinal obstructions into four separate and distinct 
forms—viz., subacute obstruction of the small intestine, 
subacute obstruction of the double colon considered 
generally and without regard to special position, sub- 
acute obstruction of the pelvic flexure of the double 
colon, and subacute obstruction of the single colon. 
Taking the three forms of intestinal obstruction I 
have mentioned in their correct anatomical order, 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 8&1 


‘subacute obstruction of the small intestine’ should 
properly have been described first. I have my reasons, 
however, for giving this general obstruction of the double 
colon prior place. Among them is the fact that it is this 
particular variety that occurs most often in practice, and 
has led to the terms ‘impaction of the bowels’ and 
‘stoppage of the bowels’ being so loosely applied to other 
and distinct types. The word ‘subacute’ is purposely 
inserted in order to exclude such acute occlusions of the 
bowels as partial or complete twist, strangulated hernia, 
intussusception, etc. That being done, we are compelled 
to a consideration of such disorders as are brought about 
by any circumstance that causes a stationary or torpid 
condition of the bowels, or the surcharging of the intestinal 
tract with bulky, indigestible food. 

The present chapter, then, is given over to the descrip- 
tion of all obstructions of a subacute type that occur in 
any position in the large or double colon, with which, 
until differential means of diagnosis present themselves, 
I include typhlitic or cecal impaction. 

Before coming to its actual description, it will be 
necessary to continue this definition further. A reference 
to Professor Friedberger’s table in Chapter I. shows 
plainly enough that it comes under the second division of 
the essential form of true colic—i.e., colic consequent upon 
anomalies of the intestinal contents. The question, then, 
arises, Will it be (a) the colic produced by overfeeding, 
or (b) the colic occasioned by stoppage in the intestinal 
canal? In my opinion, the definitions thus indicated 
are, to a very great extent, interchangeable, for in the 
colic I am about to describe (that occasioned by stoppage 
in the intestinal canal, known commonly as impac- 
tion of the intestines) there can be no doubt that over- 
feeding is responsible for a great majority of the cases. 


82 THE COMMON COLICS OF THE HORSE 


There may or may not be colic pains with the over- 
feeding, and yet the overcharging of the horse’s intestines 
may give rise to impaction, or stoppage—fecal accumula- 
tion. To make myself plainer, we may have overfeeding 
and yet no symptom of colic, until it has become really 
a case of impaction or stoppage. That is really what 
always occurs in the great majority of cases of so-called 
impaction of the intestines, the only premonitory 
symptoms (prior to constipation or stoppage) being dul- 
ness. No exhibition of abdominal pain whatever. 

Then, again, take (0), or the colic brought on by 


flatulence. Here, also, it is evident that it may arise 


merely as a result either of overfeeding or of obstruction. 
So that, to sum up, we may say: ‘ The (a) form of colic— 
viz., that produced by overfeeding— may or may not be 
accompanied by flatulence, and may or may not be pro- 
ductive of obstruction, again with or without flatulence.’ 
That is what one really sees if notes are taken of a series 
of cases, and I will endeavour to make my statement 
still clearer directly. I do not wish to convey that there 
is no such thing as a pure type of flatulent colic ; in fact, 
Chapter XV. is solely reserved for its consideration. I 
merely wish to point out that in a great many cases the 
flatulence is solely dependent on previous conditions that 
are in themselves another and distinct variety of colic. 
Causes.—For these I must again ask the reader to 
refer largely to Chapters IV. and V. He will find 
there an enumeration of such general predisposing and 
exciting causes of colic as will render my work in this 
particular section very short. I would, however, ask 
him to particularly remember what I have written re- 
garding the anatomical reasons for expecting the horse 
to be peculiarly liable to attacks of ‘colic’: the small 
size of his stomach, the great length and complicated 


ee = 


sso 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 83 


distribution of his intestines, together with their com- 
paratively fragile structure and the enormous loads they 
are called upon to carry, and the natural bars to vomition. 
His judgment should:also be guided by a due considera- 
tion of such physiological reasons as the short length of 
time the-food requires to remain in the digestive tract, 
the matter of age and defective teeth, hereditary predis- 
position, and the question of temperament. I would also 
enjoin on him not to forget the effects of change of 
climate, all those little errors resultant on the horse’s 
domestication : the matter of correct feeding and proper 
watering, the length of his hours of work and rest, and 
the number of times he is fed in the day. Among all 
these will be found numberless causes of obstructive 
colic. More particularly still would I request him to 
bear in mind such causes as the collection of sandy or 
gravelly deposits in the colon from the ingestion of fodder 
so contaminated, the weakening and lowering of tone of 
the intestinal muscles consequent on debilitating diseases, 
aneurismal interference with the blood-supply to various 
portions of the digestive tube, and the presence of the 
foetus in animals heavy with foal. 

Of these and others fuller details will be found in the 
chapters mentioned. All are likely, in their turn, to have 
a preponderating influence in determining an attack of 
‘intestinal obstruction.’ Nevertheless, we may correctly 
sum up by declaring that a very great majority of the 
causes of intestinal impaction are directly referable to 
errors in diet. 

Symptoms.—These will be found to vary, in greater 
or less degree, in nearly every case the veterinary surgeon 
is called upon to attend. Before proceeding, however, it 
will be wise to remind the reader that I am not dealing 


with acute intestinal obstruction (under which head 
6-—=2 


84 THE COMMON COLICS OF THE HORSE 


would come partial or complete twist of the bowels, etc.). 
In those cases the character of the pain is acute and 
agonizingly persistent, and the disease runs a rapid and 
fatal course of from twelve to twenty-four hours. I have 
made a second notice of the acute disorder here in order 
to firmly impress on the mind of the veterinarian that it 
will be absolutely necessary for him to negative the idea 
of his case being of that description before a suitable and 
proper treatment can be adopted. I do not imagine for 
one moment that this conclusion may be arrived at bya 
hasty and half-hearted examination of our patient; for, 
as a perusal of the table of cases at the end of this 
chapter will show, we may be deceived by the symptoms, 
the pulse, the temperature, or the respirations, or we may 
be misled by all combined, if our examination be not a 
lengthy and a searching one. 

Dull Subjective Symptoms.—The symptoms of a sub- 
acute attack will be in main what are nearly always, and 
I think correctly, described by practitioners as ‘dull 
pains.’ They are so plainly of a dull character as to” 
lead the owner to treat the case lightly and to neglect 
sending for assistance at the outset. Frequently he 
allows twelve or even twenty-four hours to elapse before 
sending for skilled advice. ‘The animal is dull and list- 
less, perhaps refuses his food, or picks a little now and 
again. At this stage the pulse, temperature, and respira- 
tions are but little altered. These, however, change as 
time goes on, and the animal begins to show signs of un- 
easiness and pain, such as walking round the box, and 
smelling at the bedding. Otherwise he leans heavily with 
his hind-quarters against the nearest post or wall, with an 
occasional pawing movement of the forelimbs or an 
irritant stamp of the hind. Perhaps the animal even 
ventures to lie down, and, if so, only after repeated and 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 85 


careful crouching movements. As he stretches himself 
out, he emits a long-drawn sigh, or a slight but lengthy 
groan, and then lies out at full length, for, it may be, an 
hour at a time. While down, his pain is manifested by 
his occasionally bringing the head round to the side, and 
looking with anxious and troubled countenance towards 
his flank. Also, the breath is held after the act of in- 
spiration, and retained until the voluntary muscle is 
overcome by the deoxygenated state of the blood in the 
vessels of the brain. After lying for some time, he will 

get up and exhibit the same set of symptoms again from 
- beginning to end. 

Dull Objective Symptoms.—Examination fer rectum will 
generally show that bowel to be empty, or containing at 
the most a few small, hard, and mucous-covered lumps. 
The bowel is sometimes, though not always, what is 
termed ‘ ballooned,’ and we may or may not notice violent 
straining and attempts on the part of the animal at de- 
feecation. It may be, however, in some cases that the 
rectum is not empty, but full, to a state of impaction, 
with material varying from a semi-fluid to a solid con- 
sistence. The bladder is usually empty, and nearly 
always other portions of the intestines can be felt crammed 
to their full with impacted fecal matter. Ascultation of 
the abdominal walls reveals not the slightest sign of peri- 
stalsis. Sometimes there is an accompanying slight tym- 
pany, and during auscultation we may then hear a peculiar 
metallic tinkle, caused by some feeble attempt of the bowel 
at peristalsis. Contrary to many, I attach no grave im- 
portance to that sound—rather the reverse. The ex- 
tremities are cold, and the mouth clammy and feetid. 
When hereafter I allude to‘ dull’ pains, I am referring to 
the symptoms described above. Often, however, we may 
have symptoms much more violent and alarming. 


86 THE COMMON COLICS OF THE HORSE 


Acute Subjective and Objective Symptoms im Subacute 
Colic._It will appear odd, I confess, to talk of the oc- 
currence of acute symptoms in subacute colic, and yet 
we must be prepared to admit that the frequent and 
vapid recovery of animals showing acute symptoms suf- 
ficiently negatives the idea of their ailment being of such 
an acute variety as twist, etc. Without attempting to 
argue that spontaneous recovery from twist, or other 
serious condition, is impossible, we may, with every 
regard for logic, allow that symptoms of an acute nature 
' 'may be observed in subacute colic. The pain becomes 
much more violent. The animal walks round and round 
his box. ‘The ears and extremities grow deathly cold. 
Cold, patchy perspirations bedew the underneath surface 
of the abdomen, and break out between the forearms and 
thighs, while the expression becomes anxious to an 
alarming degree. Tympany becomes much more notice- 
able; the animal reels in his walk, and casts himself 
down with such violence as to almost resemble a fall. 
The pulse is increased in frequency, and is not so full to 
the fingers. The visible mucous membranes become in- 
jected, and appear of a deep red hue. Frequently, too, 
in this special form of colic, the membranes are tinged 
with yellow, reminding one of the early stages of jaundice. 

Such are the usual symptoms of intestinal impaction, 
and their average duration may be anything from twelve 
or fifteen to twenty-four hours. The longest period that 
I myself remember an animal suffering, and ultimately 
recovering, is eight days. In fatal cases forty-eight 
to thirty-six hours usually sees the end. 

Diagnosis.—I am fully persuaded that this is the 
most easily diagnosed of all our cases of colic, and con- 
cerning it a mistake ought seldom or never to be made. 
Such a thing, however, as a diagnostic symptom is not 


SUBACUTE OBSTRUCTION OF. THE DOUBLE COLON 87 


to be looked for. It is only by a complete and orderly 
analysis of the whole of the history, and by a proper 
weighing up of all the signs, that a correct diagnosis can 
be arrived at. Nevertheless, upon one fact I wish to 
place the greatest possible emphasis. The value of 
taking the indications of the pulse, temperature, and 
respirations collectively, in order to avoid error in prog- 
nosis, cannot be overestimated. I never look upon 
a case as approaching dangerous unless I get a full 
warning from all three. A reference to Case No. 7, at 
the end of this chapter, will explain what I mean. Here 
was an animal which had been rolling in violent pain 
before my arrival, but was now standing perfectly quiet. 
An alarming state of the pulse was evident, hammering 
away at the rate of 108 to the minute. The temperature, 
however, was only 1o1° F., and the number of respira- 
tions 12. The animal recovered. 

Take, again, Case No.6. The respirations here were a 
continual sob of 32 to the minute, and the horse was in a 
bath of perspiration for over an hour. The pulse was only 
48, and the temperature 101°4° F. The animal recovered. 

Or take Case No. 3. The temperature, 96°6° F. (which 
may be taken as subnormal in shire horses), was counter- 
balanced by the pulse (48) and the respirations (13). 
This animal also, after a lengthy illness, recovered. 

Here I will take the opportunity of stating that I 
believe it to be absolutely impossible to diagnose 
‘straight away ’ even this, the most easily diagnosed and 
best understood of all our cases of colic. No committing 
statement ought to be made and no large amount of 
drugs exhibited until the case has been closely watched 
for some time. For example, witness Case No. 13. 
Judging from my foregoing remarks, the irregularity of 
the respirations and temperature in this case should 


88 THE COMMON COLICS OF THE HORSE 


certainly have merited a bad prognosis. Still, I was 
tempted to hold out hopes, for the reason that we had a 
perfectly normal pulse—normal in tone and normal in 
number, The conclusion of that case alone warrants me 
in giving the advice to take the pulse, temperature, and 
respirations collectively, for an hour later saw the 
character of the pulse enormously changed for the worse. 
I was compelled to give a fatal prognosis, and the animal 
died nine hours afterwards. The attentive reader will 
notice that this case was really one of acute gastric 
tympany.. It was, however, inserted with this list of 
cases of obstruction to illustrate more forcibly the 
remarks I have just made. This special attention paid 
to the character of the pulse in conjunction with the 
temperature and respirations, the symptoms I have given 
well weighed, and his own powers of observation brought 
well into play, should leave the veterinarian in a fair way 
to satisfactorily come to a right conclusion. 

Prognosis.—The subacute obstructive colics are the 
ones among these many disorders that allow the veteri- 
narian ample time in which to judge pretty accurately of 
the probable termination of the attack. 

Having diagnosed his case, and ascertained that he has 
a fairly normal pulse, he may, with every confidence, rely 
upon the great majority of his patients recovering, if not 
too seriously hampered by the administration of unsuit- 
able drugs. He should in most instances carefully 
explain the nature of the complaint to the owner; point 
out the fact that the condition of the pulse is such as to 
occasion him no alarm; advise him that an alteration in 
the pulse will be the first sign of a likely fatal conclusion ; 
and pledge himself to immediately warn his client should 
such alteration unfortunately occur. So long as the 
pulse remains good, the patient’s strength is maintained, 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 89 


and his system responds readily to the action of 
stimulants, so long may a favourable prognosis be in- 
dulged in, and the medical attendant need not necessarily 
be alarmed at the continuance of pains spread over a 
period of three or four days. In fact, the comparative 
cessation of pains, if unaccompanied by an action of the 
bowels, may sooner be regarded as an unfavourable sign. 
The time at which the circumstances look their blackest, 
when the pains are most severe, and the uninitiated 
lookers-on the most anxious, is often the turning-point in 
the case, and it is at such moments that I would carefully 
caution the worried veterinarian to rigorously hold him- 
self in check, and arbitrarily abstain from the exhibition 
of sedatives. Could he but bring himself to do so ina few 
successive cases, he would soon come to look upon the 
pain, distressing to witness no doubt, as only a necessary 
factor towards a complete and rapid resolution, and would 
be able, even in that anxious time, to hold out to the 
solicitous owner still further hopes of a near recovery. 

Treatment.—My ideas concerning this are somewhat 
unorthodox. I cannot, therefore, detail my own without 
first giving that more generally practised. Probably the 
most common of all is the administration of an aloetic 
ball, the dose varying from 6 to 7 or 8 drachms, according 
to the size and age of the animal. Those who follow 
this usually administer at the same time antispasmodics 
and anodynes. Others there are who discard the aloes; 
and rely simply upon the exhibition of the anodynes. 

For the aloes it is said that the colic in this case is 
due to a collection of irritating food in the intestine, and 
that the rational treatment is the administration of a 
purgative to remove the offending substance. 

The antispasmodics and anodynes are exhibited 
for the relief of spasm. Those who so treat their cases 


90 THE COMMON COLICS OF THE HORSE 


appear to regard spasm as a condition standing alone. 
Percivall even goes so far as to describe finding spasmed 
portions of bowel after death. He says: ‘ The seat of 
spasm, in common, is the small intestines; in particular, 
the jejunum and ileum. I have seen the duodenum, 
however, contracted as well; in one case, a few inches 
from the stomach, its canal appeared to be perfectly im- 
passable. I have also, in three or four instances, met 
with it in the large guts; in one all three of them 
exhibited evident marks of spasm; the cecum was 
exceedingly distorted by contraction; . .. even the 
rectum had manifestly been spasmed.’ 

If spasm, as spasm only, is what we are to treat in 
these cases, then the exhibition of a suitable anodyne is 
doubtless the most correct treatment. Nothing more 
need be given. Opium in the crude, as a watery decoc- 
tion, or in the form of a tincture, was usually resorted to. 
Modern treatment, however, calls for the administration 
of morphia, or morphia and atropine, hypodermically. 
Extract of cannabis indica, too, has crept to the front a 
great deal during the last few years. It is said not to 
derange the stomach and intestines to the extent that 
opium does ; that it relieves spasm and pain as quickly 
and more permanently, and without arresting the action 
of the bowels. Chloral hydrate, also, is a favourite drug 
with those who adopt this treatment. 

Even when the more simple explanation of uncom- 
plicated spasm is denied, and the case admitted to be one 
of obstruction, practitioners still continue the adminis- 
tration of sedatives or anodynes for a different reason. 
‘It is the pain,’ they say, ‘ that will wear the animal out.’ 
We are not, therefore, to administer a purgative, and 
simply wait for its operation. We must at the same 
time alleviate the animal’s sufferings. Those who 


Secor ObsoithkUCTION OF THE DOUBLE COLON 01 


follow this line of reasoning will, therefore, administer 
some such remedy as Percivall’s: 


Aloes sol. - : z ‘ Pies 
Tr. opii ke, 
Spts. eth. nit. | > aa Sl. 
Aq. fervens z j x teeye: 


Misce; fiat haust. 

In the treatment of to-day that would resolve itself 
into the administration of a 7-drachm ball of aloes, 6 to 
8 grains of morphia hypodermically, and about 2 ounces 
of spts. eth. nit., in a drench. 

In addition to the administration of sedatives alone, or 
combined aloes and anodynes, enemas are frequently 
thrown into the rectum. Many also advocate the use 
of hot fomentations to the belly, in order to promote 
peristalsis. So long as the case lingers on, the exhibition 
of sedatives in decreasing doses is persisted in; and if 
the practitioner be particularly bold, the aloes is supple- 
mented by a dose of linseed-oil. It is common, also, to 
find oil of turpentine administered to prevent the rise of 
fermentation and tympany. 

It cannot be gainsaid that the above line of treatment 
is successful. At any rate, it has been continuously 
adopted by a large number of practitioners for a great 
many years. If anything new is to be introduced, it 
must show advantage over the old. Whether or no 
the treatment I am about to advocate will do that can 
only be judged from experience. For my own part, 
it has caused me to entirely cast aside the aloes and 
anodynes in its favour. Several years’ experience of 
a solely stimulative treatment has led me to believe 
it a great deal more rational than either of those de- 
scribed, and certainly more successful. I have also found 
it wise to refrain from using aloes. A treatment based 
upon these lines I shall, therefore, next describe. 


92 THE COMMON COLICS OF THE HORSE 


The Stimulant Treatment.—When first I came to 
rely mainly upon stimulants in the treatment of equine 
colic, I naturally turned to what literature I had, in 
order to see how far I was justified in so doing. This 
surprised me. Having properly and correctly diagnosed 
a disease, I used to think that its treatment would follow 
naturally. A long plodding through the annals and 
records of veterinary medicine has shown me, however,. 
that such is not the case with this particular disorder. 
In no single disease, I should imagine, have so many and 
widely differing drugs been given. From the most potent — 
sedatives we know of to the most drastic purge or power- 
ful stimulant the Pharmacopceia possesses, they have all 
been given. Not only have they been given in the 
treatment of like disorders in different patients; they 
have been indiscriminately mixed in single cases. 

Now, I do not believe in giving purgatives and 
stimulants with one hand and administering sedatives 
with the other. Above all things, whether the occasion 
demands the exhibition of aloes, the administration of 
stimulants, or the injection of morphia and atropine, 
let us abide by the one treatment we have decided the 
case merits. 

So far as we have gone, our summing-up stands thus: 
In the treatment of subacute intestinal impaction many 
practitioners rely wholly upon sedatives; others always 
combine the sedatives or anodynes with aloes; while a 
few advocate the use of stimulants. So long as matters 
remain so, a description of any particular treatment of this 
disorder should be accompanied with fairly sound reasons 
for its recommendation. I have therefore made the few 
following pages as argumentative as possible. Without 
wishing to disturb the routine of those who have for 
many years practised a particular method with a reason- 


SOmeacore ObSTRUCTION OF THE DOUBLE COLON 93 


able amount of success—a method which, perhaps, the 
need of their district calls for—I would still wish to 
appeal strongly to those who are yet wavering. 

To commence with, provided we have diagnosed our 
case, and are certain that we have purely a condition of 
subacute intestinal obstruction to deal with, we cannot 
do better than ask ourselves the following questions: 

1. What ts the exciting cause of the aitack ? 

2. What ts the cause of the pain P 

3. What is the actual condition we ave called upon to 
tveat P 

4. What part of the animal system is tt best to operate 
through—the digestive ov the nervous ? Or should our attack 
be divected mainly upon the offending substance itself ? 

1. What 1s the exciting cause of the attack? To that 
question I answer, Undoubtedly in the great majority 
of cases it is the nature, bulk, or mode of administration 
of the horse’s food. Whether of an indigestible nature, 
given in too large a quantity, or whether given in sucha 
manner and at such a time as not to admit of a free 
action upon it by the gastric and intestinal fluids, the 
result remains the same—viz., impaction of a certain 
portion, or portions, of the alimentary tract with a mass 
of improperly digested food. 

2. What is the cause of the pam? ‘The pain, I think 
we may safely answer, is brought about by active peri- 
stalsis, followed by spasm of the bowel, either on both 
sides of, or before, or behind the point of obstruction. 
This pain, of the severity of which we may judge by 
noting the animal’s symptoms in the most acute case 
of obstruction we have—viz., twist—we may designate 
ascramp. This explanation of ‘cramp,’ however, does 
not altogether meet the case when we are talking of 
obstructive colic in its subacute form. Here, in the 


94 THE COMMON COLICS OF THE HORSE 


majority of cases, we have a state of impaction from end 
to end of the alimentary tube. What, then, will be the 
cause of the pain now? It may be, and is partly, due to 
pressure on, and consequent irritation of, the delicate 
nerve-endings in the bowels themselves. When, how- 
ever, we consider that the bowels, already crammed 
to their full with half-digested matter, are sometimes 
further distended by the evolution of gases from the 
accumulated fecal masses, we may confidently assert 
that we have another and totally different condition of 
the bowels to reckon with. I am alluding to ‘tonic 
spasm.’ When a muscle or its motor nerve receives 
an abnormal number of vibrations or is overstimulated, 
instead of contraction being followed by relaxation, 
permanent contraction or tetanus ensues. The bowels, 
distended beyond a certain point, are retained in a state 
of tonic cramp in their ineffectual attempts to deal with 
the enormous masses they contain. That this is so is 
fully proved by the entire cessation of peristalsis in many 
of our cases, as witnessed by auscultation. Call it tonic 
spasm, atony, paralysis of the bowel, or what we will, it 
still remains that we have a torpid and stationary condi- 
tion of the bowels to treat. It is this state of tonic 
spasm of the whole of the intestinal tract that has, 
in my opinion, been so generally overlooked in the 
treatment of veterinary obstructive colic. 

3. What ts the actual condition we ave called upon to 
tveat ? The favourite, but evasive, reply of the practi- 
tioner of veterinary medicine to that question is, ‘ Remove 
the cause, and the effects or actual condition will cease,’ 
and, accordingly, in every case he gives a dose of physic. 
That physic is invariably aloes. I maintain, however, 
that, before we proceed in an attempt to empty the 
bowels by such a mechanical method as the adminis- 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 95 


tration of aloes, we ought rather to stay and ask our. 
selves: ‘Can we by any other means put the tetanized 
wall into a state approaching its normal condition, and 
so enable it itself to deal with the offending obstruction ?’ 
I think we can, and, reserving my reasons for so saying, 
will conclude my remarks on this question by stating 
that, in my opinion, it is the tonic spasmodic seizure of 
the bowel itself which is the actual condition we are 
called upon to treat in obstructive colic. 

4. What part of the animal system is tt best to operate 
through—the digestive ov the nervous? Ov should our 
attack be directed mainly against the offending substance ttself ? 
The whole crux of the argument concerning the treat- 
ment of obstructive colic lies in the answer to these 
questions. For my own part, I believe that the treat- 
ment of the nervous division of this ailment should 
receive our almost undivided attention; and I further 
believe that the administration only of drugs that act 
wholly or mainly on the digestive tube itself, and not 
on its nervous supply, is unproductive of good, if not 
altogether harmful. Remember, we cannot depend on 
the physiological action of the drug being sure to ensue 
in this case. We are putting our drug into contact with 
a diseased organ, and must not expect that organ to 
take up, assimilate, and respond to that drug as the 
same organ would doin health. In this case the disease 
of the organ is its atony, spasm, or paralysis. Relieve 
that, and the bowels will relieve their impaction them- 
selves. 

Intestinal movements are dependent on the ganglia of 
Auerbach’s plexus, situated between the longitudinal 
and inner circular layersof muscle. Secretion is believed 
to be influenced by Meissner’s plexus, lying in the sub. 
mucous coat. Both of these ganglia, however, are con. 


96 THE COMMON COLICS OF THE Fenee 


trolled by cerebro-spinal centres and nerves, notably the 
vagi and the splanchnics. Here, then, is pointed out 
a ready and open road to a correct treatment, and one 
which may be followed without the aid of a single dose 
of purgative medicine. Give a large enough dose of 
a cerebro-spinal stimulant, and theoretically the case 
should at once begin to mend. Practice in this case, 
I can confidently state from experience, only bears the 
theory out. To make my standpoint clear, I must 
analyze a few of the actions of the more important drugs 
used in everyday practice in the treatment of this dis- 
order. Asin this chapter I determine to direct attention 
to what I believe to be the dangerous practice of giving 
aloes, and to the greater success following a nervous 
stimulant treatment, I shall confine myself to a few drugs 
under those headings, concluding with a brief paragraph 
on the use of anodynes and sedatives, 

(a) Aloes.—freasons advanced in favour of its administra- 
tion: It causes a purge, not only of the bowels, but also 
of the blood. While in contact with the intestine it pro- 
duces secretion and peristalsis. It also increases the 
flow of bile. 

Reasons why tt should not be used: 1. ‘The length of time 
it takes to act (sixteen to twenty-four hours) is much too 
long to have to wait in the horse for an action of the 
bowels. That must be evident to everyone in view of 
the short time that is occupied in the passage of the food 
through the digestive organs. 

2. Weare waiting then for a something only proble- 
matical ; for oftentimes it never acts at all, but is excreted 
wholly by the kidneys, causing hyperemia of those organs 
and diuresis. 

3. The drug is always more or less nauseating. 

4. Its effects are confined mainly to the large intestine ; 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 93 


consequently, if atony of the small intestine exists, it may 
never reach the position in which its action will be the 
most marked. 

5. It needs to be saponified and emulsified by bile before 
its prompt solution can be counted upon. 

These last two reasons may be considered a little more 
in detail. It is they that have already made me refer to 
the action of aloes as ‘ mechanical.’ In face of state- 
ments Nos, 4 and 5, no one will dispute that two purely 
mechanical processes have to be gone through before we 
can confidently calculate on a dose of aloes creating a 
purge. It has to pass almost passively through the small 
intestines before it can reach the large, and it requires 
also to be mechanically mixed with bile before its solution 
can be expected. Unfortunately, in subacute obstructive 
colic these very two processes that are necessary for the 
prompt action of aloes are not at all likely to come about. 
Regarding the first, I have already pointed out that there 
is very little movement of the bowels in this form of colic ; 
consequently, the drug may remain almost stationary in 
the stomach, or at the most gain the first few feet of the 
small intestines. , 

With regard to the second process comment is well- 
nigh useless. In subacute obstructive colic there very 
- frequently is considerable jaundice and torpidity of the 
liver, in which case the aloes cannot act, or, to say the 
least, its action is most certainly delayed, owing to the fact 
that the bile necessary for its prompt emulsification and 
solution is deficient or altogether wanting. 

6. Finally, in the horse there is always a danger of 
superpurgation, followed by enteritis, laminitis, or possibly 
death. ‘This ought never to be overlooked. 

I am sure that every practitioner who has been in the 
habit of exhibiting aloes in this disorder must have 

7 


98 THE COMMON COLICS OF THE HORSE 


sometimes been grievously disappointed and mortified—- 
disappointed and annoyed to see his case recover from 
the disease he has been treating it for, only to turn 
round and die in a few short hours as a result of the 
treatment itself. Truly, that treatment was worse than 
the disease. I say here that, if there is a possibility of 
that occurring in only 1 per cent. of our cases, then aloes 
ought never to be used, Asa matter of fact, when aloes 
is regularly given, it happens very much more often than 
that. 

(6) Ammonia.—Although there are many more to 
choose from, the drugs I have used as stimulants, and 
more particularly as nervous stimulants, have been 
ammonia and nux vomica. | 

For ammonia, and especially the carbonate, I have a 
particularly strong penchant. That I am not the only 
one so inclined, I will show by a few remarks extracted 
from an article on ‘Ammonia and the Stimulative System 
of Treatment in Disease.’ This was written by the late 
Principal Walley, in 1879; but, I may add, I had arrived 
at almost similar conclusions long before reading his 
opinions. He says: 

‘ Physiologically ammonia acts as a powerful stimu- 
lant, but does not, like alcohol, increase mental activity, 
nor does it to the same extent increase the force of the 
circulation. Its action as a stimulant—owing to its 
béing quickly excreted—is as fugitive as it is rapid, but 
it does not produce much secondary depression... . 
It is, too, a powerful stimulant to all the glands of the 
body, as well as to the mucous surfaces generally, acting 
upon the mucous membrane of the alimentary tract, 
upon the kidneys, the skin, and the liver. Its effects 
as a general gland stimulant are well seen in those cases 
where the pulse is firm, the skin dry, the kidneys in- 

1 See Appendix ITI, 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON g9 


active, the mucous membranes icteric, the bowels sluggish, 
and the feces coated with mucus, with a hot, dry, and 
furred condition of the mouth. A few doses of ammonia 
here will, by stimulating gland function, rapidly alter these 
conditions. In the stomach and intestines ammonia acts 
as an antacid and antitympanitic, It is useful in acute 
or subacute indigestion in horses and cattle when pur- 
gatives have failed to act, and the animal shows signs 
of exhaustion, alternated with strychnine or nux vomica. 
In the early stages of tympany, the liquor or the car- 
bonate unites with the liberated carbonic acid, and fixes 
it, and in any stage is beneficial by stimulating the 
mucous membrane to increased activity, by rousing 
nervous energy, and by assisting in preventing decom- 
position.’ 

Like Professor Walley, I can speak from experience 
as to the beneficial actions of this drug in subacute 
indigestion, and I prefer the carbonate for these reasons: 
it is less volatile and rather more permanent in its actions 
than the hydrate; also it is more easy of administration, 
as it may conveniently be given in the form of a bolus. 

(c) Nux Vomica.—I consider the use of this drug to 
be specially indicated in the treatment of subacute obstruc- 
tion. It is a gastric, vascular, and nervous tonic, and 
antiparalysant; and considering that I have already 
pointed out that the condition we are to treat in this 
disorder is mainly one of nervous atony and spasm of the 
bowel, it must be apparent to everyone that none but the 
most favourable results will follow its administration. 
I must not finish my remarks on this drug, however, 
without a brief reference to two articles in the Journal of 
Comparative Pathology and Therapeutics (vol. v.). ‘Two cases 
are reported there of salivation caused by the administra- 
tion of nux vomica in 3i. and 3ii. doses respectively. 


The dose I am about to advocate exceeds this by 6 or 
| oe 


ido THE COMMON COLICS OF THE HORSE 
7 drachms, and I can confidently assert that in no single 
case have I observed anything of a similar nature. 

(@) Turpentine.—it will be seen, on referring to the 
section on Posology, that in every case I advocate the use 
of turpentine combined with linseed-oil. I have chosen 
that drug on account of its antiseptic and stimulant 
actions. I have given it mainly to satisfy local prejudice, 
which thinks that no medicine can be a medicine unless 
in the form of a drench, and have selected it particularly 
as conforming closely to the lines on which my treatment 
is based—viz., stimulative. 

(¢) Eserine or Physostigmine.— Regarding the use 
of this preparation, I have nothing to say that is not in 
its favour. I regard it as the most valuable of all recent 
additions to veterinary medicines. Should we give it ta 
pregnant animals? In vol. 1. of the Veterinary Record 
Horner describes two cases of mares in advanced preg- 
nancy receiving one-tenth of a gramme of eserine and 
aborting soon afterwards. That should be sufficient to 
point out that its use must be tempered with caution. 
Only after all other means have failed, and it becomes 
not only a question of the life of the foal, but of that of 
the mother, should it be given. For my own part, I 
have given it to in-foal mares repeatedly, and have not 
met with an untoward result yet. With this one excep- 
tion, I firmly believe that it may be administered 
advantageously in every case of subacute obstructive 
colic. 

To those who complain of its action being uncertain 
and unreliable, I would reply in the words of one of our 
greatest veterinary writers: ‘Give a dose sufficiently 
large, and you will not be disappointed.’ It will, when 
all our other efforts have proved futile, restart that 
peristalsis, which means life to our patient, and whose 
cessation means death. I do not, however, believe a full 


i es 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON io! 


dose to be always’ necessary, and have seen doses of 
I grain do all that the most fastidious would require. 
That dose is sufficient to incite the bowels to action in 
most cases, and that without an exhausting and painful 
evacuation of large volumes of feces, If it fails, it may 
safely be repeated later in an increased quantity—say, 
2 grains, beyond which it is not wise to push its ad- 
ministration. | 

(f) Pilocarpine.—In this drug we have a most useful 
adjunct to eserine. Possessing as it does the property of 
promptly and energetically stimulating glandular secre- 
tions, including the salivary and intestinal, it at once 
recommends itself for use in the disorder we are con- 
sidering. While in eserine we have an agent which in 
large measure confines itself to exciting to action the. 
muscular coat of the bowel, we possess in pilocarpine a 
drug whose administration will cause the various gastric 
and intestinal juices to be secreted in large quantities and 
poured into the bowel. It is plain, therefore, from a 
physiological point of view, that the exhibition of a com- 
bination of these two will be an ideal method of dealing 
with obstruction caused by accumulated fecal matter, 
and accompanied with torpidity of the bowel wall. 

Practice quite bears this out. It is true that it is only 
since 1904 that I have been in the habit of using it. I 
have given it a sufficiently long trial, however, to prove 
its usefulness. ‘This, combined with eserine, I am now 
convinced is far preferable to the exhibition of eserine 
alone. As to the dose, I have found that 1 grain of 
eserine in conjunction with 2 grains of the pilocarpine is 
satisfactory and efficient. 

(g) Arecoline.—Of late years the use of arecoline 
hydrobromide as an intestinal stimulant has crept to 
the front. Its action is said to be allied to that of pilo- 
carpine, but of somewhat shorter duration. Although I 


102 THE COMMON COLICS OF THE HORSE 


have used it on several occasions, | have not been 
sufficiently impressed by the results obtained to substitute 
it for the combination of eserine and pilocarpine. 

(h) Sedatives.—Our choice of these is a large one, 
but before saying more I would ask: ‘ Should we give 
sedatives at all in obstructive colic?’ Personally, I 
think we should not. I know that in saying so I am 
opposed to a large number of practitioners, but still, 
after the experience of a very large number of cases, 
such is my conviction. In the horse I am convinced 
we have a type of colic to deal with that can in no 
way whatever be compared with the same disorder in 
the human subject; and when reading the report of a 
case, nothing gives me greater annoyance than to find 
the veterinary writer trying, in conclusion, to bolster 
up his theories, arguments, and treatment with extracts 
from books on human medicine. As a profession, we 
are undoubtedly largely indebted to the medical for 
much kind help afforded us in the first tottering steps of 
our babyhood. Now, however, we can and must stand 
alone. We have here a subject that fairly allows us to 
do so. It needs a distinct and totally different line of 
thought from that the medical profession can supply us 
with in order to enable us to properly grapple with it. 
There is still room for special research of the most pains- 
taking order. What is wanted is a long array of con- 
secutive cases, with notes and remarks taken on the 
spot, and not afterwards altered and enlarged in order to 
fit in with some preconceived idea. In the tabulation of 
cases, points invariably strike one that would otherwise 
be missed—points of value and interest that only a 
method like that will show up. 

Think for a moment. Think that immediately we 
give a sedative, especially if that sedative be opium, 
peristalsis is hindered, if not stopped altogether, for a 


Te re 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 103 


while, Think, again, that cessation of peristalsis, if only 
of a few hours’ duration, is to the horse a very grave and 
serious matter. It is no use blinding ourselves with the 
idea that, if aloes has previously been given, we may 
safely lull the pain while the aloes continues to act. 
Remember that ‘ lulling the pain’ to a very great extent 
means also ‘lulling the physic,’ and that lulling the 
bowels in the horse suffering from subacute obstruction, 
with bowels already stagnant, means lulling him to death. 
Although I do not advise it, to those who must and will 
use a sedative, let me recommend to them the use of 
chloral hydrate in 1-ounce doses in preference to opium. 
It is antiseptic in its action ; there are not the after bad 
constipating effects of opium, there is not that mad 
delirium, and there is not the amount of dangerous 
tympany that opium invariably calls up. It is safe to 
use, its action is soon apparent—usually well within ten 
minutes—and if its effects are somewhat transient, why, 
then the same dose may safely be repeated after a short 
space of time. It is not followed by nausea, and, com- 
pared with opium, it does not seriously interfere with the 
peristaltic movements, and does not hinder intestinal 
secretions, Here, again, I have notes of a case in front 
of me where the veterinary writer states that medical 
men pooh-pooh the idea of chloral being of any use in 
these cases. Well, let them doso. ‘They are not in the 
habit of prescribing for the horse, they are not acquainted 
with his internal anatomy, and they certainly are not 
largely experienced in the action of drugs upon him. 
That chloral is not an anodyne in the strict sense of the 
word, I know. I know that it does not act as a sedative 
to the periphery of sensory nerves. It acts, however, in 
an indirect manner through the nerve-centres, and almost 
invariably induces sleep. Compare the stretched-out, 
comfortable sleep of the griped animal under the in- 


> 


104 THE COMMON COLICS OF THE HORSE 


fluence of chloral with the mad delirium so often seen 
with opium, and one can no longer remain in doubt as to 
the superiority of the former in treating equine colic. 

Here are a few of Mr. Hunting’s remarks on the use 
of sedatives in colic, and with them I must close. He 
says: ‘It was argued that in the human subject they 
administered sedatives with the intention of alleviating 
the pain, and when they had once stopped the spasm 
there was no fear of impaction. After the spasm was 
got rid of, that the normal condition of the bowels 
would be resumed, and the indigestion pass away. 
Personally, he (Mr. Hunting) believed that, so far as the 
horse was concerned, that was arguing upside down. 
He held that the impacted food was the cause of the 
spasm or pain, and that the proper thing to do was to 
remove the cause, even if they inflicted a little more pain. 
He could say honestly and fairly that he had had a 
greater number of recoveries under the aperient and 
stimulant treatment than under the sedative treatment 
alone.’ 

I can emphatically endorse all that Mr. Hunting says 
there. The same good results immediately followed 
when I refrained from giving sedatives. I am able, 
moreover, to assure the practitioner that the number of 
his successful cases would further increase if he also 
discontinued the use of aloes, and substituted linseed- 
oil. 

Posology.—Provided the animal is suffering from a 
bad attack of the disorder, with all the symptoms well 
marked, and the least possible chance of error in diagnosis, 
I exhibit the following: 


R.. Ammon. carb. pulv. - - $i. 
Nucis vom, pulv. : *. eae 
Sapo mollis - . ---q.s, ut fiat bol, 


Misce ; fiat bol. iv, 
Sig. : The four balls to be given at once. 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 105 


Fy. Ol. tereb. . i . Sa Bi 
Spt. ammon, ar. 
Ol. lini - : - - « jad-O.1 


Misce ; fiat haust. 
Sig. : The drench to be given at once, 


This treatment, with the exception of the nux vomica, 
I repeat again at the expiration of three to four, five, or 
six hours if the animal is stillin pain. In the meantime 
I throw up frequent enemata of hot water, with some- 
times the addition of 4 to 6 ounces of ordinary soap 
liniment. Should the case tend in any way to become 
protracted, and if the pulse is strong and not too frequent, 
I inject hypodermically eserine sulphate, 1 grain. If on 
the next occasion of my seeing the case there has been 
no action of the bowels, and peristalsis is still in abeyance, 
I repeat the eserine in larger quantities—viz., 2 grains. 

The preparation of eserine that I have found to be the 
most reliable is the following : 

R. Eserine sulph. - . - grs. viii. 


Aq. chloroformi - - ad 3i. 
Dose, 1 to 2 drachms. 


I would recommend every practitioner to prepare this 
himself. He will have the satisfaction of knowing 
exactly the strength of his injection, and he may rely on 
that preparation keeping practically for any length of 
time. It should be made in fairly large quantities 
(say 12 ounces), and, during the handling of the raw 
drug, it should be remembered that it is highly hygro- 
scopic. 

So long as the animal remains ill, I continue the 
administration of ammonium carbonate, this time com- 
bined with zingib. rad. pulv. in place of nux vomica. In 
fact, it may be taken as a general rule that from the com- 

1 This, too, may be obtained in tablet form, in varying combina- 


tions with pilocarpine, and quite reliably dispensed, from any firm 
of druggists of repute, 


106 THE COMMON COLICS OF THE HORSE 


mencement of the pains until relief is obtained ammonium 
carbonat3 may be given at intervals of three hours in 
I to 2 ounce doses. 

The only modification to be made is when treating a 
very young cart animal or a nag. In this case the dose 
of nux vomica should be reduced to half an ounce. 

Should the reader think these doses too large, I would 
ask him to remember that the results embodied in the 
writing of this chapter are the outcome of several years’ 
sole practice of the treatment here laid down, and that 
nothing but the marvellous and striking statistics 
following its adoption have led me to give to it the 
prominence I have done in the past few pages. 

To anyone who might feel disposed to adopt it 1 
would offer a few words of caution. If carried out in a 
half-hearted manner—the doses reduced by one-half to 
guard against accident, or the administration of eserine 
deferred until the patient is in a state of collapse—then 
he may look for nothing but failure. Having diagnosed 
his case, the veterinarian must be possessed of the 
courage of his convictions, and be prepared to push them 
to their ultimate and right conclusion. 

Should he doubt, should he waver, I am able to 
honestly assure him that I have seen no case in which 
the apparently excessive doses have proved in any way 
harmful. On the contrary, after the experience of a long 
array of cases, I am able to declare the exact opposite to 
be the fact, and am thereby led to insist so strongly on 
the correctness of the treatment. In the whole of my 
practice for certainly the last five or six years I have 
had no occasion save one to give aloes. That occasion 
is included in the list of cases at the end of this chapter, 
and I may say that, even then, I had serious cause to 
regret its administration. ‘This section on posology is 
the one I would ask the reader to ponder over most, If 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 107 


my description of the disorder is correct, there can be no 
doubt that the treatment is right in every detail. 

To further set at rest the mind of those who think the 
doses of ammonium carbonate beyond all reasonable 
limit, I may state here that one animal, in addition to 
the usual doses of nux vomica and ol. tereb., received 
considerably over 1 pound of that drug—i pound in 
2-ounce doses spread over a period of thirty hours. I 
need hardly say it was an extreme case. It is the 
occurrence of cases like that which has proved to me the 
value of the treatment—cases that, under the old treat- 
ment of aloes and sedatives, invariably used to die. 
Only a few trials will convince any unbiassed mind of 
the splendidly beneficial action of a solely stimulative 
treatment.+ 

Although very much more might be written on this 
subject, I feel that already this chapter is lengthy enough. 
My main object has been to point out what I believe to 
be the dangerous though common practice of administer- 
ing aloes or sedatives to the horse suffering from 
intestinal obstruction in its subacute form. One can 
always see more, feel more, and know more than one can 
write. It is not easy to gather up, classify, and tabulate 
all the facts, theories, and circumstances that lead one to 
a certain conclusion. It is still less easy to so arrange 
those facts as to carry conviction to the minds of others. 
If I have failed in that, 1 have failed in a good cause. 
lf I have been successful, I am conscious of having per- 
formed a good work for my brother veterinarian, for the 
stock-owner, and for our equine patients. 

1 See also Part II. of Appendix. 


108 THE COMMON COLICS OF THE HORSE 


REPORT ON EIGHTEEN CONSECUTIVE CASES OF 


Va. 


‘Oe Subject 3 
of | Date. \Time. ~ 
aoe and Age. c 


Resp. Conjunc- 


Since how Diet. 
tiva. 


long Lie. 


Temp. 


r |Oct.10,| 7.30 | 5-years- 70 | 101°6 14 Injected. 
1898. | p.m. | old cart 
gelding. 


————— 


7 a.m. | No green meat. 

same day.| A mixture of 
maize, boiled 
potatoes, and 
barley - meal ; 
soaked linseed 
cake. 


cart cut new oat 
gelding. straw; soaked 
linseed cake. 


6 p.m. | New oats, he euk 

of 11th. oat straw, old 
hay, kohl 
rabi; soaked 
linseed cake. 


3 |Oct.12.| 2.30 | 22-years-| 48 99°6 13 Highly 
p.m. | old black injected. 
cart mare; and 
had been yellow. 
used 
largely for 
breeding ; 
barren. 


Oct. 13. | 10.30 — 48 996 13 Do. 
a.m. 


Oct. 14. | 10.30 — 88 | 10 13 Do. — 
a.m. 


2 |Oct.11.} 8.45 | 13-years-| 88 | 103°4 36 Highly | 11am. | Ground maize, 
p-m. | old brown injected. |same day.| new oats, and 


ee 


ee ee ee en 


Water- 
supply. 


Drain 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 


109 


SureacUrE OBSTRUCTIVE INTESTINAL COLIC. 


Previous 


Medicine. M edicine given. 


At 7.30 p.m. 
Ammon. carb., 2} oz. 
Nucis vom. p., 1 oz. 
Sapo mollis, q.s. 

M. ; ft. bol. iv. 


Rain. Nil. 


At 9.30 p.m. 
Ol. tereb., 2 oz. 
Spt. ammon. ar., 1 02. 
» | OL lini, x pint. 
M.; ft. haust. 


Ol. lini, 


(dyke).| 1 pint. Nucis vom. p., I 02. 
Sapo mollis, q.s. 


M. ; ft. bol. iv. 


enone ot rer 


Nil. 
Nucis vom. p., I 0z. 

Sapo mollis, q.s. 
M.; ft. bol. iv. 


Injected hypodermically : 
Eserine sulph., 2 grs. 


— Treated exactly as 


previous day, with ex- 
ception of eserine. Ene- 


mata given. 


_ Treated as on 12th, with 
the addition of a hypo- 
dermic dose of eserine, 


3% grs. 


Ammon. carb. p., 2 oz. 


Ammon. carb. p., 2 oz. 


Dull pains at intervals. Lying quiet. Stand- 


Syniptoms, Remarks, ete. 


ing quiet. Eating occasionally. Rectum 
empty and ballooned. I watched this case 
three-quarters of an hour before pain was 
evinced at all, and nearly left the farm 
declaring to the owner that I had been 
called out for nothing. I did not see the 
case again, and it afterwards did well. 


General dull pains, with excessive strain- 


ing attempt» at defzcation at intervals, 
Symptoms somewhat masked, owing to 
pneumonia (congestive stage) set up by 
the inspired linseed-oil given by the owner. 
Impossible, or rather unwise, to drench. 
The rectum contained a few hard lumps 
covered with mucus, and the bowel was 
ballooned. 


Animal quite well in all respects. 


Dull heavy pains the whole time. Never 


violent. Impossible to drench owing to 
awkwardness. Rectum empty and bal- 
looned. Other bowels, as far as could be 
felt, impacted. No peristalsis on auscul- 


tation. 


Mare much weaker, and evidently, owing 


to old age, unable to stand against the 
attack. Rectum still empty and ballooned. 
No fzeces had yet been passed. 


Still no faeces had been passed, and still no 


evidence of peristalsis could be gained by 
auscultation. The temperature, however, 
was decidedly improved; and the pulse, 
having gained in strength and become 
more full to the touch, indicated that the 
mare would still stand active treatment. 
Accordingly, I repeated the previous treat- 
ment, and also ventured on another and 
larger dose of eserine sulphate, with the 
happiest results. The bowels answered 
to the stimulus, and the case afterwards 
did well. 


t10 


THE COMMON COLICS OF THE HORSE 


REPORT ON EIGHTEEN CONSECUTIVE CASES OF 


J oN Sphere 
Se Date. |Time. and Age S & Resp. 
4 | Oct. 14.| 10.15 | 6-years- 68 | 1014 13 
p.m _|old in-foal 
chestnut 
cart mare 
5 | Oct. 15.| 20.45.| 7-years- | 48 | a0r4%) A con- 
p.m. | old cart tinual 
gelding. sob of 
32 per 
minute. 
Oct. 16.|8 a.m. — ~— _ _ 
| 
6 | Oct. 17.] 10.45 | 14-years- | 52 IOI £3 
| a.m. | old nag 
; gelding, 
property 
of a 
: miller. 
7 | Oct. 27.| 6.30 | 24-years- | 108 | 100 12 
p.m. jold brown 
cart 
gelding. 
Oct. 28.| 7.30 — 50 | I00°2 12 
a.m. 
8 |Nov.17.| 7.30 | 5-years- 70 IOI 13 
p-m. | old roan 
nag 
stallion. 
- 62 IOI 13 


Conjunc- 
tiva. 


° 


Injected 
and 
yellow. 


Injected 
and 
yellow. 


Injected 
and 
yellow. 


Injected. 


Injected 
and 
yellow. 


Since how 


long Ile. eee 


Injected. | 3.30 p.m. | Soaked split 


maize and new 
oats, with bran, 
cut oat straw, 
old hay, and 
linseed cake. 


same day. 


7p.m. | Green clover, 
same day.| bran, wheat, 
sharps, and 
cut hay and 
straw. 
7 p.m. | Wheat chaff, 
of 16th. maize, and 
bran. 


3.30 p.m. | Maize, cut oat 
straw, wheat 
chaff, soaked 
linseed cake. 


Out at pasture, 
but receiving 
twice daily 
two feeds of 
maize, oats, 
and wheat 


chaff. 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 111 


SUBACUTE OBSTRUCTIVE INTESTINAL COLIC—continued. 


ee 


Water-\| Previous 


sty.| Medicine. Medicine given. Symptoms, Remarks, ctc. | 
Dirty | Ol. lini, | Ammon. carb. p., 2 oz. Usual dull pains. Animal subject to these 
drain. I pint. Nucis vom. p., 1 oz. attacks, and with difficulty rallied from one 
‘| Sapo mollis, q.-s. in August, 1896, when I treated her with 
M.; ft. bol. iv. aloes and anodynes. I did not see the case 


again, but the owner afterwards informed 
me that the mare did well. 


=~ ee 


Drain | Ol. lini. | Ammon. carb., 2 oz. Pains violent. Animal almost ungovernable. 
(dyke). | Ol. tereb. | Nucis vom. p., 1 0z. Ears and extremities cold. Cold sweat 
small Sapo mollis, q.s. bedewing underneath surface of abdomen, 

quantity. M.; ft. bol. iv. and between the forearms and thighs. 

« | Spt. ammon. ar. ee Expression anxious. Rectum empty, 

Ol. tereb. a art ballooned, and dry. Bladder empty. I 

Ol. lini, 10 oz. watched the case for an hour, during which 

M.; ft. haust. there was not one moment of ease. I left 


| Hypodermically: Eserine| her in pain. 
sulph., 2 grs. 


— = _ Mare quite well. I learned from the owner 
that the animal gained ease at 3 a.m., and 
first passed at 7 a.m. a large mass of yellow 
mucus weighing 3 pounds, together with a 
few hard knots of feces, which were saved 
for my inspection. 


Soak or} Ol. lini, | Ammon. carb., 23 oz. Usual dull heavy pains. Rectum contained 
surface-| 1 pint. Nucis vom. p., 14 oz. a few hard mucus-covered lumps, and was 
well. Sapo mollis, q.s. ballooned. Other intestines (colon) could 
I. 5 ft..bol. iv. be felt impacted. Bladder empty. Did 

Ol. tereb. \ not see the case again. Did well. 


Spt. ammon. ar. f 2 3 ©: 
Ol. lini, 12 oz. 
NM.* ft: hast. 


Soak or a As Case 4. Had been in violent pain, but on my arrival 
surface- was standing perfectly quiet. The counte- 
well. nance, however, looked anxious, and I 
was, to say the least of it, alarmed at the 

state of his pulse. 


— — Did not treat. All symptoms of pain absent. 
Drain | Ol. lini, | Ammon. carb. p., 2 oz. Usual dull pains. No evidence of peristal- 
(dyke). | 1 pint. Nucis vom. p., I oz. sis on auscultation. There had been no 
Sapo mollis, q-s. evacuation of feeces all day, but the rectum 
M.; ft. bol. iv. was full of a semi-fluid dark-green mass. 
Ol. tereb. This I removed, and gave enemata. 


a& 2 Oz. 


Spt. ammon. ar. 
O]. lini, 12 oz. 
M.; ft. haust. 

a _ Repeated the same treat- | Rectum again full, but there had been no 
ment, with the addition voluntary evacuation of its contents. ‘The 
of eserine sulphate, 2 grs. case subsequently did well, and there was 

no purging. 


—<————$ 


aes 


tf2 THE COMMON COLICS OF THE HORSE 
REPORT ON EIGHTEEN CONSECUTIVE CASES OF 
fe; Dac THe Subject = $ Resp Conjunc- | Since how Diet 
SS . ; , 
aot and Age Ry & tiva. long Lil. 
g |Nov. 23.| 10.30 |Aged(15?)} 57 | 10r"4 12 Injected. | Found ill | Cut oat straw, 
a.m in-foal ats5a.m.| wheat. chaff, 
cart mare. same day.| maize. 
Nov. 23.| 12.30 —_ — — = = — -~ 
p-m 
Nov. 23.|7 p-m _ 46 | 102 12 — — a 
ror Nov. 30. S-years- | 62 | 101 17 Normal. | 6a.m. | Bran, maize, 
p-m. | old chest- same day.| linseed, cut 
nut cart ; oat straw, and 
gelding. wheat chaff. 
Nov. 30| 10 - — —_— — — — —_ 
p-m. 
Dec. 1. | 7 a-m _- a — — -- —_ = 
rz | Dec. 5. | 9-20 | 5-years- 65. tan 15 Injected. | 12 noon | Maize, bran, 
p-m.| old nag same day.| ground wheat, 
mare ; cut oat straw. 
barren. 
Dec. 6. | 12 — — — =~ — _ — 
noon. 
Dec. 7. | “12 srg — —“ = — = —_ 
noon. 
12 5 Dec. 22.| 11.30] 2-years- | 44 to | 104°4 28, Injected.| 3 p.m. | Cut oat sheaves, 
p-m.| old cart }74, ac- sobbing same day.| bran, maize, 
gelding. | cord- mangels. 
ing to 
pain. 


1 On the night of November 30 I had also two other cases of a similar nature. 


Circumstances did not permit — 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 113 


SUBACUTE OBSTRUCTIVE INTESTINAL COLIC—continued. 


Weater-\| Previous 


supply.| Medicine. Medicine given. Symptoms, Remarks, etc. 
‘Dyke. Nil. Ammon. carb., 23 oz. Periods of dull pain. Violent at intervals, 
: -| Nucis vom. p., 6 drs. Slight tympany. Rectum empty and 
Sapo mollis, q.S. ballooned. 
ft. bol. iv. 
Drench. as for No. 8. 
— = Injected hypodermically : | No change whatever. 
Eserine sulphate, 2 grs. E & 
— a — Mare quite easy. One hour after the injec- 


tion of the eserine and during the day 
there had been several evacuations of feeces 
of a normal consistence, accompanied by 
the discharge of much flatus. 


Dyke. Nil. Same as No. 8, with addi- | Dull pains. Rectum ballooned and contain- 
tion of eserine sulph.,| ing a few hard mucus-covered lumps. 
2 grs. Colon impacted. No signs of peristalsis 


on auscultation. Tympany very marked. 
This I tried to relieve with the trocar, but, 
failing twice, desisted at owner’s urgent 
request. 


— _— ~ The eserine had greatly increased peristalsis, 
but as yet there had been no passage of 
feeces. 

a _— oe Horse quite easy. Slightly purging. Case 

did well. 
Surface - Nil. Ammon. carb., 2 oz. Sharp pain at intervals. For the most part 
well. Nucis vom., 1 oz. remaining dull. Eating at intervals. No 
Sapo mollis. q GS. tympany. Rectum full of a semi-fluid, 
= ft. bol. iv: half - digested material, resembling more, 
Spt. ammon. ar. both in smell and appearance, the contents 
Ol. tereb. haa ath of a stomach. 
Ol. lini, 19 oz. 
M.; ft. haust. 
-- -- I was in this case tempted | The mare continued dull all day. Purged 
by the owner to give a towards evening. This purging I could 
| dose of aloes, 7 drs. not attribute to the aloes, as it was too 
. soon after its administration. 

_ _— ~. Mare still continued dull and listless, but 

picking a little. Dung of a normal con- 

| sistence. She then purged again towards 
evening (this time, I think, from the aloes), 

| | and caused me no little anxiety for some 

i few days, fearing superpurgation as a con- 

sequence of the already irritated bowels. 

Dyke. Nil. As Case 11, but no aloes. | Pains violent and almost incessant. Per- 
One bour later, eserine spiration in patches, but animal warm. 
sulph., 2 grs. Anxious, distressed look. Mouth dry, | 


clammy, and hot. The horse got relief at 
3-30 a.m. on 23rd. 


These were treated on identical lines with the foregoing, and did well. 
of my reporting them in full. : 


THE COMMON COLICS OF THE HORSE 


{14 
REPORT ON EIGHTEEN CONSECUTIVE CASES OF 
Vo. . = S ; : 
Subject x S Conjunc- |\Since how : 
oe Date and Age. & ae Resp. tiva. long Ile. Diet. 
3 |Jan- 27, 22-years-| 54 98°4 35, Injected. | 12 noon | 15 pounds of 
1899. old brown hurried, same day.| material per 
cart short, diem, consist- 
gelding. and ing of maize, 
gasping. Ca parts), 
wheat (1 
pact), oa't 
Straw and 
wheat chaff. 

14 | Feb. 7. |5 p.m.| 13-years-| 52 992 20 Injected | 12 noon | 1 stone or more 

old in-foal and same day.| per diem of 
half-strain yellow. maize, bran, 
mare. and wheat 
! sharps, with 
| cut oat straw. 
One third of 
the mixture 

was wheat. 

Feb. 7. | 10.30 — 48 | 100 13 — oo _ 
p-m. 

15 | Feb. 8. |8 p.m.| 4-years- | 40 | too 16 Normal. | 6p.m. |? stone of 
old cart same day.| mixture of 
gelding. maize, oats, 

and ground 
wheat. Oat 
straw, hay 
chaff, and 
carrots. 

16 |Feb. 13./7 p.m.| 4-years- | 50 | 101°4 20 Normal. | 3.30 p.m. | 1 stone or more 

old brown same day.| per diem of 
cart oats, With oat 
gelding. straw and cut 


hay. 


\ 
> 
. 

.¥ 

-< 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 115 


SUBACUTE OBSTRUCTIVE INTESTINAL COLIC—continued. 


Previous 
Medicine. 


Water- 


supply Symptoms, Renarks, etc. 


Medicine given. 


Started work at 7 a.m. Continued well until 
12.30. Received the mid-day meal, im- 
mediately after which she was ill. Bathed 
in perspiration. Pains violent and inces- 
sant. No tympany of bowels. Rectum 
and colon, as far as could be felt, empty. 
Rectum flaccid. Continually looking round 
at stomach (not flank). Medicine return- 
ing through nose. MRegurgitations in 
cesophagus. Pulse gradually got higher 
in number and weaker in tone, and one 
hour after my first arrival I diagnosed 
tympany of stomach, with possible rupture 
and death. Death occurred at 1 a.m. of 
28th, and I much regret that circumstances 
did not allow of a post-mortem being made. 
There was no rupture of stomach. This 
case shows that too great a reliance must 
| not be placed on the indications of pulse, 

temperature, and respiration in the first 

stages of colic. 


Ol. lini, | As Case rz. No eserine. 
I pint. In this case the bowels had 
j been greatly emptied by 
repeated evacuations of 
small quantities of faeces 
before my arrival. 


Dyke. 


* 


Surface - Nil. As Case 11, but no aloes. | Pains dull when animal was down. Violent 
well. At 6 p.m. injected eserine | whenup. With difficulty could keep mare 
sulph., 1 gr. on her legs. Much groaning and painful 


attempts at defecation. Rectum empty 
and ballooned, but mare had passed a few 
hard lumps of mucus-covered dung during 
the day. Slight tympany, but no sign of 
peristalsis on auscultation. Animal was at 
work from 7 to 11 a.m. 


we. Mare quite easy. Drank water greedily. 
Picking her bedding. Food withheld until 
morning. Had passed immense quantities 
of flatus and one large heap of feces. 


Ammon. carb., 2 oz. Animal had been at work in the morning. 
Nucis vom., 1 oz. Dull pains. Rectum ballooned and con- 
Sapo mollis, q.s. taining three or four fairly soft dung-balls. 
Bi, ; ft. bol. iv. Other bowels could be. felt impacted. 
Spt. ammon. ar. ) -- Bladder empty. Case did well. 
Ol. tereb. jaa ~ Sipe 
Ol. lini, 10 oz. 
M.; ft. haust. 
Gin, As Case 15. Dull pains. Groaning when lying. No 
ginger, peristalsis on auscultation. No tympany. 
opium, and Rectum full; flaccid when emptied. Case 
linseed-oil. did well. 


a 


a 


116 THE COMMON COLICS OF THE HORSE 


REPORT ON EIGHTEEN CONSECUTIVE CASES OF 


A 


| 
: Subject Conjunc- 
ce Date. \Time. and Age: & Resp. Pett 
a Villar 56. 26.] 3.30 | 5-years- 72 | 101°2 13 Injected. 


p-m. | old brown 


Since how 
long Lll 


Diet. 


Pulse. 


Maize, cut oat 
straw, man- 
gels, and lin- 


10.30 a.m. 
same day. 


cart 


| gelding. seed cake. 
| Mar. 26.| 9.30 — 50 (| IOI 13 _— _— = 
p-m. 
Mar. 27.| 10.30 — 65 | 10%%2 13 Normal. 
| a.M- 
Mar. 27.| 5.30 ~— 46 | 101 13 Normal. 
p.m. 
18 | April 1.| 10.30] ro-years-| 72, | 103 Ly, Normal. 3p-m Wheat chaff, 
p.m. | old cart | inter- sobbing. same day cut oat straw, 
mare; | mit- oats, linseed 
barren. | tent. cake, man- 
gels. 
April 1.| 11.45 — 
p-m. 
April 1.|8 a.m. — 


April 1.] 12.45 _ 
a.m. 


Peete ObSTRUCTION OF THE DOUBLE COLON | 117 


SUBACUTE OBSTRUCTIVE INTESTINAL COLIC—continued. 


Water-| Previous 


paige. | Medecine. Medicine given. Symptoms, Remarks, ete. 
hard, mucus-covered lumps. 
a _ Enemata and_ repeated | Slight peristalsis. Animal apparently easy, 
smaller doses of am-]| but no action of bowels. 
monia and nux vomica. 
= as Ammon. carb., 2 oz. Rectum still empty and ballooned. Peris- 
Nucis vom., 1 oz. talsis quite absent. Usual dull pains. 
Sapo mollis, q.s. No tympany. Animal was quite easy all 
_M.; ft. bol. iv. night, but pains commenced again at 
Ol. lini, 1 pint (haust). 5.30a.m. After giving the medicines and 
Hypodermically : Eserine injecting the 2 grains of eserine, I left 
sulph., 2 grs. the case until 11.40. During my absence 
of a little under an hour the horse had 


evacuated several copious lots of semi-fluid 
feeces, preceded by one or two mucus- 
covered hard quantities. Seeing the 
eserine was still in operation, and that a 
sufficient action had been arrived at, I 
injected an ordinary dose of morphia and 


atropine. ; 

a —_ No treatment. Animal standing up eating a bran mash and 
apparently comfortable. Case did well 
afterwards. 

Drain. Nil. Ammon. carb., 2 oz. Dull pains. No tympany. No peristalsis. 
Nucis vom., 1 oz. Rectum ballooned, containing a few hard, 
Sapo mollis, q.s. mucus-covered lumps. Straining attempts 
4. it. bol. iv. at defeecation when hand was introduced. 
Spt. ammon. ar. ) -- 
Ol. tereb. \ aa 24 02. 


Ol. lini, 1 pint. 
M.; ft. haust. 
Hypodermically: Eserine 
sulph., 2 grs. 
—_ -- Injected hypodermically, | Still in pain, but bowels acting freely. 
morphia and atropine, 
to stay excessive action 
of bowels from eserine. 


ng = Gave boli, as before. Arimal in pain and peristalsis again in abey- 
ance, owing to the sedative. Did not this 
time give eserine, but relied solely on 
ammonia carbonate and nux vomica. 

= — ~ Animal easy and picking a little food. Case 


. and eserine sulph., 2 grs. Rectum ballooned, and containing a few 
afterwards did well. 


Drain. Nil. As Case 15, Dull pains. No tympany. No 


118 THE COMMON COLICS OF THE HORSE 


The stimulative treatment advised in the foregoing 
pages was first published in Ig00. Since then it has been 
favourably mentioned by Mr. E. R. Harding, M.R.C.V.S., 
of Salisbury, who made it the subject of an address 
delivered before the members of the Southern Counties 
Veterinary Medical Society in 1g01. The subject of 
Mr. Harding’s remarks was the ‘ Treatment of Intestinal 
Impaction.’ For his words I am indebted to the report 
contained in the Veterinary Record. They are as 
follows: 

‘My reason for choosing this subject was, not that I 
have anything original to offer you, but rather the 
reverse. It is to give you my experience of the treat- 
ment advocated in a very able article by Mr. H. Caulton 
Reeks, F.R.C.V.S., of Spalding, Lincolnshire, which 
appeared in the Jouynal of Comparative Pathology and 
Therapeutics for March, 1900. 

‘The disease is a common one to practitioners in 
agricultural districts, owing mainly to the domestic mis- 
management of the farmer’s horses. The system which 
prevails in the district in which I practise seems to be 
pretty general. The horses have their first meal about 
five o'clock in the morning. It consists of a small portion 
of corn, generally soaked maize; in some cases half 
maize and oats. With this is mixed a large quantity of 
wheat or oat hulls or cut straw chaff. After they have 
been feeding on this for an hour and a half, they are 
turned out to drink, then harnessed, and start for work 
at seven. ‘They are kept at it, with fut very few excep- 
tions, without more food or water, until between three 
and four in the afternoon. They certainly have a rest 
about noon, when the men get their lunch, but they have 
to stand in their harness, mayhap, in the hot sun or cold 


1 Veterinary Record, vol, xiv., p. 108, 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 1g 


wind and rain. When they return to the stable they 
have a similar large feed to the morning one—if anything, 
a little more—without any water until after they have 
finished. They are then turned out to the trough, and 
we can imagine the quantity they drink after eating such 
a large meal and working all day. In a few cases nose- 
_ bags are provided for them at noon, and on those farms 
“‘ colic” cases are not so frequent. 

‘The exciting causes, then, may be said to be the long 
intervals between feeding and the large amount of in- 
digestible food given them at each meal. 

‘The symptoms of a subacute case are those which do 
not give rise to any alarm on the part of the owner or 
attendants. The animal looks dull, refuses food, lies 
down in the natural position, and remains quiet for some 
little time, with the exception, perhaps, of looking round 
tohis flanks. Hewill then get up and pick a few mouth- 
fuls of straw. After standing for some little time, pawing 
occasionally, he will gradually make up his mind to lie 
down again. There may be little or no tympany, the 
pulse, temperature, and respirations practically normal ; 
examination pey vectwm will reveal that bowel to be 
almost empty, while other portions of the intestines will 
be found to be full of a mass of dough-like feeces. ‘There 
will be an entire absence of abdominal sounds. If relief 
be not afforded, the symptoms will soon become more 
alarming. The animal will be up and down constantly, 
and, when down, rolling; in fact, not still a moment. 
The tympany becomes much greater, and he breaks out 
in patches of sweat; pulse and respirations accelerated. 
Oftentimes we are too late to watch the subacute 
symptoms, but on our arrival the patient is in a desperate 
condition, perspiration literally pouring from him, great 
tympany, pulse nearly 100, respirations much accelerated, 


120 THE COMMON COLICS OF THE HORSE 


nostrils dilated, an anxious expression—in fact, apparently 
dying. 

‘I should like here to quotea . poten from Mr. Reeks’ 
article. Hesays: ‘‘I cannot lay too great a stress on the 
value of taking the indications of the pulse, temperature, 
and respirations collectively, in order to avoid error in 
prognosis. I never look upon a case as approaching 
dangerous unless I get a full warning from all three.” 
Then he refers to a case in which the animal had been 
rolling in violent pain before his arrival, but was then 
standing perfectly quiet with a pulse hammering away at 
108. But the temperature was only Io1, and respira- 
tions 12. The animal recovered. 

‘Treatment.—In my younger days this consisted of 
aloes and opium or belladonna, with warm water enemas. 
This was successful to a certain degree, but there was 
frequently two days’ purging. About twelve or fourteen 
years ago eserine was introduced, and I have used it ever 
since, and, with Mr. Reeks, I have nothing to say of it 
which is not in its favour. But itis his nervous stimulant 
tveatment to which I wish to draw your attention.1 I must 
quote from himagain. He says: ‘‘ The bowels, distended 
beyond a certain point, are retained in a state of tonic 


cramp in their ineffectual attempts to deal with the ~ 


enormous masses they contain, and then we have a torpid 
and stationary condition of the bowels to treat.” 

‘ The treatment he advocates is a large dose of a cerebro- 
spinal stimulant, and he chooses carbonate of ammonia 
and nux vomica. I must admit to being astonished at his 
dose, viz., 2 ounces ammon. carb. and I ounce nux vom., 
made into four balls and given at once—that is, to a big 
agricultural horse, with well-marked symptoms. ‘This is 
followed by a draught consisting of 2 ounces of spts. 


1 The italics are mine.—H. C. R, 


SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 121 


tereb. and spts. ammon. arom. and a pint of ol. lini. He 
repeats the ammon. carb., substituting pulv. zingib. for 
nux vomica in three to four, five, or six hours, if the 
animal is still in pain, and in the meantime gives 
frequent hot-water enemas. Should the case tend to 
become protracted, and the pulse is strong and not too 
frequent, he injects hypodermically eserine  sulph. 
I grain, and if on the next visit the bowels have not 
acted, he gives eserine sulph. 2 grains, still continuing 
the ammon. carb. 

‘I have adopted this treatment with a little modification with 

great success! The patients recover much more quickly, 
and without the nausea and purging occasioned by 
aloes. I at once inject hypodermically 2 grains of eserine, 
and give the dose of ammonia and nux vomica in three 
balls, and leave the draught to be given in two hours. 
In many cases this has effected a cure, but if there is no 
improvement in six or eight hours I repeat the ammonia 
and sometimes the eserine. if the horse is very tym- 
panitic, I puncture the bowel with the trocar and cannula 
before injecting the eserine. In several cases in which 
the first dose of eserine did not give the required result 
I have repeated the 2 grains in two hours with excel- 
lent results. I never give aloes nov opium now.) 
Since I have adopted this treatment the horses get 
better much more quickly. It used to be two or three 
days, but now I seldom have a case last more than 
thirty-six hours.’ 

The reading of Mr. Harding’s paper led me to write 
asking him to favour me with a short report of some of 
his cases. He was kind enough to forward the following 
history of three selected cases of obstruction : 


1 The italics are mizve,—H. C, R. 


THE COMMON COLICS OF THE HORSE 


i22 


"YJa] [ Tye 


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jnq ‘ured 91371] & Ul [[MWs ‘Of' Je Jay Yo] J “109e] 
yos ainb yng ‘prey Isiy ye ‘saoqy JO UOTJENOvAD 
snoidoo psonpoid siyy, ‘aUliasa jo ssop puoses 
eaes os ‘Zuluinje1 soyuedutA} pue ‘193}0q 
ou SBM d9YS 4I0]9,.0 vely1 JW “A[UO sniey jo 
UOIJNIVAD PSONPUl aullesy *][NJ STemoq 1ayj0 
‘ Ayduis winjde1 


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snjey yonu pur ‘autiess ay} Aq pasveiour yonw 
uOOS SBM SIS[TeIseaq ‘jyeoas Aaa AuedwAyT, 
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{ny uewopqy 


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— 


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‘sis z * yd[ns sul1asy 


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sis z ‘-yd[ns aulsesy 


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‘ZO & ©woA SION 
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‘Zo @ “*qivd “uUOWUlWYy 


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pur ‘sjny 
yeaym 
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Chat TER X 


SUBACUTE OBSTRUCTION OF THE 
Peeyic FLEXURE OF THE 
DOUBLE COLON 


Definition.—So long as the full wording of this chapter 
heading is adhered to, no definition will be needed. It 
sufficiently explains itself. 

On reference to p. 81 it will be seen that the preceding 
chapter is ‘given over to all obstructions of a subacute 
type that occur in any position in the large or double 
colon.’ No attempt is made there to indicate any special 
seat of trouble, or to single out any particular portion of 
the colon’s course as calling for more than ordinary 
mention. At the time when that was written—namely, 
in 1902—I did not feel that I had anything sufficiently 
clear in the shape of a differential diagnosis to offer. 
Nevertheless, it will be noticed that, even then, I 
indicated, if only vaguely, that such might be furnished 
by fuller investigation. 

Since that time, a record of several cases, together 
with the evidence gathered during post-mortems of twist 
of the double colon, has shown me that often we have a 
form of obstruction mainly, if not entirely, confined to 
the pelvic flexure of that bowel. It has shown me, too, 
that quite often the condition may be diagnosed, and the 

123 


124 THE COMMON COLICS OF THE VHOGRSs 


exact nature of the case explained to the owner. If only 


for this last reason, seeing the added reputation it gives 
to the veterinarian, it merits recording. 


Fic. 8.—TuHE NorRMAL COLON EXPOSED, AND ITS PELVIC 
FLEXURE DRAWN OUT FROM THE ABDOMEN. 


i, 2, 3, and 4, The first, second, third, and fourth portions, 
respectively, of the bowel; 5, the pelvic flexure. 


Causes.—Putting on one side the causes of colic 
generally, merely referring the reader to Chapters IV. 
and V., we shall still find one or two reasons why 


obstruction should be specially prone to occur at the 


ome Oesl RUCTION OF THE PELVIC FLEXURE 125 


point with which we are dealing. We shall find these 
in the anatomical arrangement and distribution of this 
portion of the colon. 

The first point of importance is the fact that in this 
position there is a somewhat marked constriction in the 
lumen of the gut. Considering the two portions of the 
colon forming the flexure—namely, the second and the 
third—we see at once that while the second portion, from 
the suprasternal flexure backwards, is of considerable 
size, the third is comparatively small. 

Further, we notice that the diminution in lumen is 
not gradual, but that it occurs with some degree of 
suddenness, thus occasioning the constriction referred to. 
A glance at Fig. 8 will explain. 

It needs no great amount of demonstration to point 
out that the circumference of the bowel taken around the 
second portion at a point indicated by the dotted line a 3, 
is distinctly larger than when taken around the pelvic 
flexure atc d. ‘This, as a matter of fact, is more evident 
with the actual bowel before one than with merely the 
photograph to refer to. It is distinctly more marked, 
too, in an animal that has been taking a normal amount 
of food. In the case from which this illustration was 
taken the animal had died from a wasting disease, and 
the bowels were comparatively empty. 

In so much as that to some extent it exaggerates this 
difference in size between the second and the third 
portions of the colon, Fig. 9 will more clearly illustrate it. 

This is a photograph of one of the several cases of 
twist of the pelvic flexure that have come under my 
notice. Here, owing to the displacement of the bowel, 
the ingesta is prevented from passing out of the second 
portion of the bowel into the third. The second portion 
is therefore shown distended to the full with accumulated 


126 THE COMMON COLICS OF THE HORSE 


ingesta, while the third is nearly empty. In this manner 
the abrupt transition from the bulky and voluminous 
form of the second portion to the small and comparatively 
shrunken build of the third portion is accentuated. In 


Fic. 9.—VOLVULUS OR TWIST OF THE PELVIC FLEXURE OF THE 
LARGE COLON, ILLUSTRATING THE DIFFERENCE IN SIZE 
BETWEEN THE SECOND AND THIRD PORTIONS OF THE BOWEL. 


1, 2,and 3, The first, second, and third portions, respectively, of the 
bowel. Note.—The fourth portion is hidden from sight, 


such a case as this it might be that either the accumu- 
lated feecal matter in the end of the second portion, by 
reason of cramp-like efforts on the part of the bowel to 
pass it along, was responsible for the twist, or that the 


SUBACUTE OBSTRUCTION OF THE PELVIC FLEXURE 127 


twist itself was accountable for the engorgement of the 
distended second portion of the bowel. Of that I may 
have more to say at some future date. It is sufficient 
now if it serves to point out the difference in size of 
these two sections of the colon, and the special lability 
of this portion of the intestinal tract to trouble accruing 
from obstruction. 

In order to make this point quite clear, I insert here a 
further photograph of the same case of twist (see Fig. 10). 


Fic. 10.—VOLVULUS OF THE PELVIC FLEXURE OF THE COLON— 
THE COLON PULLED OUT FROM THE ABDOMEN AND EXTENDED, 


1, The pelvic flexure of the bowel ; 2, the second portion; 
and 3, the third portion of the bowel. 


Here we have the suprasternal and diaphragmatic 
flexures obliterated by removing the colon from the body 
and drawing it out to its full length. The marked 
difference in size of the two portions of the bowel we are 
considering is then made quite apparent. Portion 
number three, nearly empty, lying beneath the over- 


128 THE COMMON COLICS OF THE HORSE 


charged portion number two, looks small almost to the 
point of being shrunken. 

A further anatomical fact of importance to be noted in 
this connection is that a portion of bowel with such an 
abrupt turn in it as this pelvic flexure should have so 
free a distribution in the abdomen. We have here a 
bowel several feet in length, of voluminous build, and 
designed to carry enormous weights of ingesta, with a 
heavy and unattached end. Devoid of mesenteric or 
other stay to hold it in position, this: heavy end is free to 
move at will in the abdomen. This must, one would 
think, lead at times to troubles which could easily be re- 
ferred to slight displacement. One could easily imagine, 
for instance, that displacement, similar to that depicted 
in Fig. 10, though less in degree, would be able to occur 
to the point of engendering a troublesome case of obstruc- 
tion, without leading to actual twist, or causing the 
animal’s death. At any rate, it is astonishing how often 
in cases of obstructive colic one is able to feel per vectum 
this particular portion of the intestinal tract quite plainly 
in a state of dangerous engorgement. 

Again, though to some extent it may be labouring the 
point, I think another reason for tendency to obstruction 
at this particular spot may be found in a physiological 
explanation. Comparable to the sluggishness of the 
circulation in the distal end of a limb, we may take it 
that the force of the blood-supply at the pelvic flexure is 
not so great as elsewhere in the bowel. It is, of course, 
at the extreme end of both the direct and retrograde 
colic arteries; and if stasis of the bowel wall is ever due 
to imperfect circulation, which in other portions of this 
work we have admitted it is, then one would quite 
expect to find the pelvic flexure one of the seats of 
trouble when such cause is in operation, 


SUBACUTE OBSTRUCTION OF THE PELVIC FLEXURE 129 

As a matter of fact, cases that occur in practice bear 
out this latter contention. More often than not the 
subject of subacute obstruction of the pelvic flexure is an 
aged animal. Several other causes, it is true, have at 
the same time to be reckoned with. Imperfectly masti- 
cated food, growing diminution in the proper secretion 
of gastric and intestinal fluids, and the gradual lessening 
in nerve force consequent on senility, all play a part in 
determining an attack of obstruction in a bowel so 
voluminous in extent and so peculiar in build as the 
double colon of the horse. Add to these facts the 
further reasons that I have here endeavoured to explain, 
and it will be seen that obstruction of the pelvic flexure 
is quite often a thing to be looked for. 

In conclusion, I may add that I have not yet met with 
a case of this description in a nag animal. It appears 
mainly to occur in animals of a heavy and lymphatic 
type, owing partly, perhaps, to the larger size of the 
colon, but more certainly to the grosser manner in 
which some of these animals are fed. 

Symptoms.—Again the general symptoms of subacute 
obstruction of the colon, as detailed in Chapter IX., are 
to be expected. To those I have nothing to add. There 
are, however, one or two points concerning them that in 
this particular connection require to be dwelt on. 

Quite a prominent feature in a case of pelvic obstruc- 
tion is the ‘ dull’ character of the pains, which dulness 
has for so long been associated with impaction of the 
colon. Although at times there is evidence of restless- 
ness, a troubled walk round the box, anxious looks round 
at the flank, and patchy perspirations, the animal is able 
to remain for the greater part of the time in a comfort- 
_able stretched-out position on the floor. In this manner 
rest is often taken for long periods at a time. Save for 


9 


i30 THE COMMON COLICS OF THE HORSE 


the fact that occasionally the head is lifted, while the 
animal stares with what might best be termed a 
‘puzzled’ expression into his flank, the ordinary looker- 
on would see nothing very untoward. 

The pulse, taken at these times, is always reassuring 
to the veterinary attendant. In so far as the number of 
its beats is concerned, it is little, if any, disturbed from 
the normal. It is firm and full to the fingers, and in no 
way at all offers suggestion of anything grave. 

Called in at such a moment as this, the veterinary 
surgeon, unless he methodically makes a rectal examina- 
tion in every case of colic he attends, may dismiss the 
case rather lightly. He will simply administer the usual 
dose of aperient medicine and such other remedies as he 
deems the case necessitates, probably concluding by 
suggesting to the owner that a further visit will be 
unnecessary—that a few hours hence will see the end of 
the trouble. 

‘In such a case as I am describing, however, he will 
most certainly be called in again. ‘This time he may be 
fortunate enough to find his patient in one of the periods 
of unrest. The pulse is then plainly disturbed, Flutter- 
ing and irregular, and accelerated in number of beats, it 
is plainly indicating that some more serious condition 
than at first the surgeon suspected is in existence. Patchy 
perspirations bedew the body, and the respirations become 
quickened in number. 

At this point the veterinary surgeon may be informed 
that since his last visit the patient has passed several 
different lots of faces. In no great quantity at one time, 
he is told, but in quite little lots. Led to it by further 
questioning, the owner also informs him that even prior 
to the time of his first visit this has been going on. The 
veterinary surgeon is thus brought up against the fact 


“a at ee 


Semeur Obst RUCTION OF THE PELVIC FLEXURE 131 


that, if only in separately small quantities, some con- 
siderable amount of feces, when taken in the bulk, has 
been expelled, and this, too, during such time as the 
animal has plainly been suffering from obstruction. 

If he has not already done so, he is led at this stage 
to explore the rectum. He finds it empty, open, and 
ballooned. He finds further that, within easy reach of 
his arm, his hand comes into contact with a portion of 
impacted intestine of considerable size, which leads him 
at once to a correct understanding of his case. 

Diagnosis.—This is arrived at by further manipula- 
tion of the impacted bowel. ‘The surgeon finds that, 
although larger in size, and probably not so angular, it is 
comparable in shape to the flexed knee of a man pushed 
there towards him. What he is feeling is the impacted 
pelvic flexure. That at its point of constriction (see 
where the number 5 is placed on Fig. 8) represents the 
knee; and the surgeon, passing from one side to the 
other of this central point, makes out with the flat of his 
hand the rounded and engorged portions of the bowel, 
which, to heighten the rough simile he has already 
framed, he may compare to the calf and the thigh of the 
flexed imaginary limb. 

In other cases, according to the position the impacted 
bowel has taken up, it suggests to the exploring hand 
the further simile of a partly developed foetus. ‘This is 
the more noticeable when, by reason of its increased size 
or other cause, the whole thing has taken up a more 
central position than is normal. 

_ As to the nature of the contents, these are quite hard, 
and can only with difficulty be indented with the fingeis 
pressing on them. 

_ Inasmuch as that in the following chapter I shall deal 
with a further form of obstruction which may also be 


Q—2 


132 THE COMMON COLICS OF THE HORSE 


felt per vectum—namely, obstruction of the single colon— 
it is necessary at this point to show means of differentia- 
tion. A reference to that chapter will show that in the 
condition there described we have a set of general 
symptoms far more alarming, ‘There is continuous pain, 
an always troubled state of the pulse, a tendency to stand 
in a stretched-out position, with ejected penis and quiver- 
ing tail, and a gradual increase in the severity of the 
pains unless the condition is soon relieved. Also we 
have violent straining attempts at defecation and a 
clinging grasp of the rectum on the inserted arm, 
together with a violently expulsive action of the bowel, 
called forth at once by anything inserted therein. 

Without committing myself to the statement that none 
of these symptoms are ever witnessed in a case of 
obstruction of the pelvic flexure, I can unhesitatingly 
declare that they are never marked. I can further 
assure the reader that in no instance will more than one 
or two of these more serious signs be seen at one and 
the same time. 

So far as he is yet able to sum up his case, the 
veterinarian 1s now confident that he has before him a 
case of obstruction implicating to a grave extent the 
pelvic flexure of the colon, and he is able to read at its 
full value a symptom that until now may have been 
somewhat puzzling. I refer to the constant evacuation 
of small quantities of faeces. It appears now that the 
single colon, and also the third and fourth portions of the 
double colon, have, in irritable manner, been discharging 
their contents. It appears, further, that nothing now 
remains to hinder the normal evacuation of the contents 
of the rest of the intestinal tract save the obstruction at 
the pelvic flexure. 

One other point has yet to be decided before his 


SUBACUTE OBSTRUCTION OFTHE PELVIC FLEXURE 133 


diagnosis is complete. Is there or is there not displace- 
ment of the bowel to the extent of actual twist ? Although 
for some years I have been looking for it, I cannot yet 
say definitely that I have been able to detect any pecu- 
liarity, either in the shape or in the distribution of the 
bowel that I can put down as diagnostic. So far, how- 
ever, as my knowledge of these cases at present goes, I 
am of the opinion that in nearly every instance where 
this knee-shaped and ingesta-packed piece of bowel is 
present in the pelvis it may be taken as certain that twist 
has mot occurred. My reason for advancing this opinion 
is that in nearly every case of volvulus of the large colon, 
the diagnosis of which I have afterwards verified at post- 
mortem, the pelvic flexure is displaced to the extent of 
removing it from reach by way of the rectum. 

Prognosis.—In face of the opinion I have offered, 
that once this condition is diagnosed volvulus is unlikely 
to be in existence, I still advise that only a guarded 
prognosis should be given. It may be that further inves- 
tigation still will reveal the fact that such a condition as 
this may occur concomitantly with twist. This advice, 
however, applies only to that occasion on which during 
his visits the surgeon is first aware of the exact nature of 
his case. He should then explain to the owner exactly 
what he is dealing with,! tell him that relief will certainly 
not be obtained for several hours, and, finally, if only 
to protect himself against contingencies, suggest the 
possibility of twist. 

After this, should his next visits find the pulse still 
near the normal, and his patient still exhibiting long 


1 J have found that a very convenient method of doing this is to 
lay out on the floor an ordinary roller-towel, doubled ia such a way 
as to represent nearly the course of the double colon in the abdomen. 
--H, C.R, 


134 THE COMMON COLICS OF THE FIGKSE 


periods of freedom from acute pain, he may, notwith- 
standing the fact that somewhat alarming paroxysms 
occur at intervals, indulge in a more favourable forecast. 
Such paroxysms as then occur may be taken as evidence 
that the bowel is attempting to deal with the adverse 
circumstances under which it is placed. In other words, 
it is but a sign that the administered purgative is acting, 
and that the obstruction is being moved. 

Treatment.—In no particular does this offer any 
special difficulty. It is quite evident, even from the 
commencement of the case, that what we have to treat 
is a torpid condition of the bowel wall. After what I 
have written in the previous chapter, therefore, I need 
hardly say that, whatever else we do, we should carefully 
abstain from the use of sedatives. They can but render 
worse what is already a sufficiently bad case. Instead, I 
again advise the exhibition of stimulants, and, in such a 
case as this, we are wise if we suggest their administration 
at very frequent intervals. The balls of ammonium 
carbonate and nux vomica may, therefore, be given as 
before, and followed up at intervals of a few hours with 
other balls of ammonium carbonate, combined this time 
with zingib. rad. pulv. instead of the nux vomica. 

Quite early in the case a reliable purgative should be 
administered. This may be either full doses of linseed 
oil, or an aloetic ball of medium strength. Regarding 
the latter, 1 have found that 6 drams is a suitable dose 
for a large cart animal, while to a nag I make a practice 
of giving somewhat less. All we have to bear in mind 
in this connection is that the dose shall be such as to 
allow of a vigorous stimulant treatment being afterwards 
maintained without risk of superpurgation. 

While busy with the treatment, it is well for the 
practitioner to mention to the owner the fact that in this 


SUBACUTE OBSTRUCTION OF THE PELVIC FLEXURE 135 


particular form of colic speedy relief need not be looked 
for. Quite confidently he may predict that some eighteen 
to twenty-four hours must elapse after administration of 
the purgative before cessation of the pains may be ex- 
pected. 

Should the case linger longer than this, which in an 
aged animal it is very apt to do, I have found the patient 
to derive great benefit indeed from hypodermic doses of 
ether, given in sufficiently large doses to maintain the 
flagging energies of the heart. It is astonishing how 
soon the drug, administered in this way, exerts its effects. 
The irregular circulation is almost immediately equalized; 
the pulse becomes somewhat slower, but stronger and 
fuller; and at the same time action of the bowels is 
certainly promoted. In fact, the best way in which one 
can sum up its effects is to use the comprehensive 
expression that it ‘gives tone’ to the system generally. 

Next, as to the administration of eserine. So far as 
my own experience goes, I may say at once that in 
obstruction of the pelvic flexure I have found it unwise 
to exhibit this drug in the early stages of the case. Had 
that not been so, I should have mentioned it before. 
We have here an obstruction within easy reach of the 
hand, the changes in the consistency of which can be 
noted hourly; and it seems a far more desirable thing, 
to my mind, to wait until the administered medicines 
have effected some degree of softening therein before we 
push the bowel to extreme efforts to dislodge it. Given 
earlier, it is productive of acute pain, and with no bene- 
ficial result, so far as one can see, to the patient. 
Directly, however, one is able to detect some tendency 
on the part of the obstruction towards softening down, 
then the eserine may be administered with the happiest 
results. 


136 THE COMMON COLICS OF THE HORSE 


One further point in the treatment and I have done. 
It is important, however. On no account should the 
constant throwing into the rectum of warm enemata be 
neglected. I had almost said they should be ‘hot.’ At 
any rate, they should be as near that as prudence directs. 
The rectum is ballooned, and fluid thrown in is retained 
some little while. Although not in actual contact with 
the obstruction itself, such fluid occupies as nearly that 
position as one could wish, only the thin walls of the 
rectum and the colon lying between it and the offending 
substance. I am unaware of any proved process by 
which such fluid may percolate through or become 
absorbed. It certainly appears, however, that some 
such process is in operation, or that the continual 
application of warmth by this means to the wall of the 
colon excites it to increased secretion. At any rate, the 
obstruction is slowly but plainly softened.} 

To do good, these enemata must be frequent. Hourly 
injections are not at all too frequent. Far from irritating 
the patient, as one might perhaps expect, they appear to 
exert a soothing influence, and play a safe and effectual 
part in bringing about resolution. 


1 See here also Chapter XIII., on ‘Intestinal Irrigation in 
Obstructions of the Colon,’ and refer to the case on page 169. 


CHAPTER XI 


SUBACUTE OBSTRUCTION OF THE 
SINGLE COLON 


Definition.—Obstruction or stoppage of a subacute type 
occurring in the single or floating colon, or in the rectum. 
For my purpose in this chapter I have considered the 
rectum as, what it really is. the last portion of the small 
colon, and shall therefore refer to rectal impaction under 
this heading. 

Causes.— Without referring the reader to any general 
cause other than those already mentioned in Chapters IV., 
V., and IX., I would ask him to remember one or two 
peculiar to this disorder only. Anatomically the build, 
and physiologically the function, of the floating colon 
offer two fairly powerful predisposing incentives to 
obstruction, and that of a rather dangerous type. 

Firstly, the sacculated nature of this viscus is such 
that it compresses the fecal matters into rounded or 
oval-shaped masses, peculiarly fitted to form obstructive 
lumps when other causes favouring impaction concur. 

Secondly, the function of this intestine is largely to 
complete the absorption of the fluid matters of the ali- 
ment, and we may easily understand, when this absorp- 
tion of fluid is carried on to an abnormal extent (as, to 
offer a simple instance, in a case of acute and prolonged 


138 THE COMMON COLICS OF THE HORSE 


febrile disturbance), how that the accumulated lumps of 
faecal matter become so hardened by the withdrawal of 
moisture as to seriously prejudice their chance of effectual 
displacement by normal intestinal movements, 

Also, regarding this portion of the intestinal tract, 
some little attention should be paid to the consideration 
of nervous trouble as a primary cause. I do not wish 
the reader to imagine anything obscure in its nature or 
of comparatively rare occurrence. It is something quite 
simple to understand, and of more or less every-day 
happening. Everyone is aware of the fact that a nerve 
is paralyzed—its function temporarily inhibited—by being 
in contact with an overworked or tired muscle, a muscle 
that is impregnated with effete materials that its long 
continuing work has left it too fatigued to rid itself of. 
It may be, perhaps out of sympathy, perhaps by a 
process of absorption whereby it takes up a certain 
amount of the poisonous muscle waste, that nerves or 
nerve-centres in close apposition with such overworked 
muscles become paralyzed, and fail temporarily to per- 
form their proper function. 

In this manner the posterior mesenteric plexus (formed 
in great part by the lumbar portion of the great sym- 
pathetic system, and furnishing branches for the supply 
of the small colon and the rectum) may often be so 
induced to a state of dangerous lethargy. The lumbar 
portion of the sympathetic, lying as it does in close con- 
tact with the psoz muscles, and being largely covered by 
the posterior vena cava, would be almost the first nerve- 
centre supplying the intestinal tract to feel the ill effects 
of the waste materials from the muscles of the hind 
limbs and the loins. At any rate, whatever the explana- 
tion may be, it is certain that prolonged and excessive 
work, especially that of a heavy hauling nature, telling 


SUBACUTE OBSTRUCTION OF THE SINGLE COLON 139 


principally on the muscles of the lumbar region, has a 
peculiar depressive action on the urinary apparatus and 
the last portions of the bowels—a depressive action that 
effectually tends to a torpid and stationary condition of 
the bowel contents. 

We are not to be greatly surprised, then, that the 
effects of a long day’s heavy carting are likely, from a 
constipating point, to settle themselves in the small 
colon or rectum. 

Apart from this temporary derangement of the nervous 
system, the practitioner will occasionally—very occasion- 
ally—meet with cases of total paralysis of the rectal walls, 
which, until noticed and correctly treated, will again lead 
to subacute obstruction. 

Symptoms.—All the usual symptoms of colic will be 
found in evidence here. ‘There is the usual getting up 
and down, the anxious looks round to the flank, the 
patchy perspirations, and the common changes in the 
temperature and respirations. The pulse, almost from 
the very commencement of the case, is weak, or, rather, 
undecided, in character, at one moment filling the artery 
to a comfortable firmness, at another dwindling down to 
an indistinctness nearing the imperceptible. This may 
all occur within a few seconds and during one observa- 
tion, and its number of beats will vary from 70 to 80 or 
go per minute. 

Compared with the other two forms of obstructive 
colic, there is not that period of total ease so frequently 
occurring between the paroxysms of pain. In obstruc- 
tion of the double colon, for instance, we commonly 
have periods of ease in which the pulse drops to a 
normal condition, both regarding its tone and number 
of beats. 

in obstructions of the single colon that seldom or 


140 THE COMMON COLICS OF THE HORSE 


never occurs. What does happen, however, is so mis- 
leading to the casual observer and of such importance to 
the careful inquirer as to merit special attention. The 
patient, certainly for some few minutes, will stand, to 
outward appearances, quiet. If the judgment is hurried, 
this will be confused with the usual period of ease in 
ordinary colic. The case will be dismissed as ‘ nothing 
dangerous.’ The pulse tells a different tale. It is still 
maintaining a troubled, fluttering beat of 70 to 8o, and is 
evidence enough of serious conditions within. ‘The con- 
junctiva is reddened, though not to such a degree as the 
continuous pains would at first appear to point to, while 
the perspirations mentioned above do not incline to 
become cold or clammy. 

If not relieved, towards the end of the first twelve 
hours the animal shows more or less tendency to stand 
in a stretched-out condition, as though attempting to 
urinate. The marked frequency with which this stretch- 
ing occurs in this form of colic is a warrant sufficient for 
pointing it out as a special symptom. 

Later, the periods of apparent ease become fewer and 
farther between, and the animal is in more or less 
constant pain. Another symptom, frequent to a point 
approaching the diagnostic, is violent straining, which is 
persisted in with such force as to move the onlookers to 
fear for the patient’s safety. During the straining the 
patient emits a series of painful groans, and the mucous 
lining of the rectum is often everted to the extent of 
several inches. If a mare, and especially if she be with 
foal, the vulva is in like manner everted, and the pains 
sometimes of such a severity as to suggest the act of 
foaling. 

The hand inserted in the rectum is met by a violent 
expulsive action of the bowel, accompanied by straining 


SUBACUTE OBSTRUCTION OF THE SINGLE COLON 141 


efforts on the part of the patient, while the bowel itself 
exerts a peculiar glove-like clasp upon the arm. 

The pelvis is found to contain portions of bowel beyond 
its normal contents: if small intestines, empty ; if single 
colon, more or less impacted with ingesta. Sometimes 
it fortunately happens that the very portion of bowel 
giving rise to the trouble is well within reach of the 
operator’s arm. If so, no further doubt as to the exact 
nature of the case he is treating need remain in his mind. 

In different cases the obstructed bowel varies in shape 
and size from a small portion resembling a large cocoa- 
nut to an impacted length of from 6 to 12 inches. That 
this impacted portion is the actual cause of trouble is 
fairly evidenced by the symptoms induced by its manipu- 
lation. Pressure on it, even if of a careful and tentative 
nature, will cause the patient to evince unmistakable 
signs of pain. Swerving from side to side, he endeavours 
to escape the inserted arm; and, persisted in, the 
manipulative movements will bring him with successive 
crouching gestures to the ground. 

In most cases, contrary to what one would imagine, 
tympany is absent ; and it is only towards the end of the 
attack, when the case is approaching a fatal termination, 
that it occurs to any appreciable extent. Enemas intro 
duced with a nozzle of ordinary length are not retained, 
but forcibly ejected almost immediately after their in- 
jection. 

Should the case be one of rectal impaction, its nature 
will at once be apparent directly the hand is introduced 
into the rectum; and, so far as the purposes of this 
chapter are concerned, a consideration of its other 
Symptoms is unnecessary. Provided the animal is 
healthily strong prior to the attack, and his end is not 
hastened by the exhibition of sedatives or violent purga- 


142 THE COMMON COLICS OF THE HORSE 


tives, the case is of a somewhat lengthy nature, and may 
not near its conclusion until the third or fourth day. 

Diagnosis.—In some cases this is remarkably simple ; 
in others just as difficult. After all is said and done, 
there can be but one absolutely diagnostic symptom, and 
that is the detecting, by manipulative measures in the 
rectum, of the offending portion of bowel. 

It will be seen, however, that I have carefully refrained 
from giving symptoms which might be truthfully de- 
scribed as general, from which I wish the reader to infer 
that such few as I have related I wish to be regarded as 
reasonably diagnostic. That being so, I will conclude 
this paragraph by simply summing them up again in 
brief. 

The continuousness of the pain, as evidenced by the 
state of the pulse, without definite concomitant symptoms 
pointing to a more grave condition, as, for example, 
enteritis, twist, or rupture; the tendency to stand in a 
stretched-out posture, with ejected penis and quivering 
tail; the gradual increase in the severity of the pains if 
not soon relieved; the violent straining attempts at de- 
feecation, and the clinging, clutch-like grasp of the rectum 
on the operator’s arm; the violently expulsive action of 
the rectum on anything introduced pey anum, and the 
presence in the pelvis of distended or flaccid coils of in- 
testine—all these are symptoms requiring careful con- 
sideration when summing up for a diagnosis. 

Without rashly venturing the opinion that these mani- 
festations may be relied upon to furnish a correct verdict 
in every case, I am, nevertheless, fully decided that many 
of these attacks will thus be absolutely differentiated 
from other forms of colic, and a corresponding improve- 
ment in the treatment be the happy result. In course of 
time this should lead to the report of further cases by 


Su eacull OFSTRUCTION OF THE SINGLE COLON 143 


other veterinarians, and an increase of information on this 
particular subject should be engendered by the working 
upon it of more than one set of brains. 

Prognosis.—In a former chapter of this book I have 
definitely stated that any case of colic is to be regarded 
as serious if distended coils of intestine are to be found in 
the pelvis. A consideration of such cases of obstruction 
of the single colon as have fallen to my share leads me 
in no great degree to deviate from that earlier-formed 
conclusion. I therefore feel myself justified in advising 
the veterinarian to offer his client a cautious and guarded 
explanation of the state of affairs. Should the day 
fortunately arise when operative interference with the 
horse’s abdomen becomes a more frequent occurrence, 
then this particular form of colic will be the first to 
benefit thereby, and so yield a prognosis of a more 
favourable type. If the case is one of rectal paralysis, 
pure and simple, then the prognosis must be even more 
guarded still. These cases are generally insidious in 
their onset, and usually unaffected by therapeutic 
measures. _ 

Treatment.—Tahking the case of total paralysis of the 
vectal walls first, we may dispose of it very briefly by 
saying that a trial should be given to a long course of 
nervine tonics—e.g., strychnia, which tonic is well accom- 
panied by potassium iodide as a resorbent. ‘The applica- 
tion of a smart blister to the lumbar region should be 
advised, and the patient’s daily comfort should be insured 
by removing from the rectum several times per diem 
the accumulated fecal matters. 

Concerning the wmpaction of the colon, 1 would, as for the 
other forms of subacute obstruction, advocate the 
adoption of purely stimulative measures; in which case 
the balls of ammonium carbonate and nux vomica may 


144 THE COMMON COLICS OF THE HORSE 


be administered as for the colic treated of in the last two 
chapters. These should again be followed up by the 
regular administration (every two, three, or four hours) 
of boli of zingib. rad. pulv. and ammonium carbonate, 
together with the exhibition of copious oleaginous 
draughts combined with ol. tereb. and ether meth., ol. 
menth. pip., spt. eth. nit., or any other diffusible tee: 
lant that may suggest itself. 

Although it is not my own practice, I would also 
mention that a dose of aloes is not seriously contra- 
indicated. In fact, in this instance, there is only one 
argument that can fairly be advanced against it, and 
that is the fact that in some cases aloes does not act at 
all, but passes off by the kidneys. Should that happen, 
the veterinarian unfortunately receives no intimation 
thereof, and is thereby restrained (by fear of causing 
superpurgation) from pushing on that vigorous stimula- 
tive treatment which his own common-sense would 
immediately suggest were he only positively certain of 
the non-acting of the drug upon which he has placed 
reliance. 

After the expiration of ten to twelve hours, should the 
case show no improvement, it will be necessary to 
seriously consider the advisability or otherwise of ad- 
ministering a hypodermic dose of eserine, regarding 
which I have a remark to make. I do not pretend to 
offer any explanation of the fact, but I do most con- 
fidently assert that in this particular form of obstruction 
eserine does not show itself to its happiest advantage. 
To my mind that points out a satisfactory solution of 
what was to me at one time a serious problem, I could 
not understand veterinarians of experience rising to their 
feet at various meetings and emphatically declaring 
eserine to be of no value in colic cases: that it did not 


SUBACUTE OBSTRUCTION OF THE SINGLE COLON 145 


act as it was said to do. In the light of fuller experience 
Iam able to see an adequate reason. They had not used 
eserine on suitable cases. In spite of my opinion that 
this is not its happiest forte, however, it still remains a 
fact that eserine does act occasionally, even in posterior 
obstruction of the colon; and, after other remedies have 
been given a trial of from ten to twelve hours, its exhibition 
should no longer be delayed. The dose should not bea 
large one. Should it fail to act, as I have already said 
it may do, then the active peristalsis set up in the 
intestines anterior to the seat of obstruction is extremely 
likely to lead to a fatal lesion of the intestines or the 
mesenteric bloodvessels. ‘There is, however, no risk in 
the administration of a small dose, say one grain. 

In view of what I have said concerning the likely 
nervous causation of this disorder, no one, I should 
imagine, will expect me to advocate the use of sedatives. 
If it were possible to do so, I would denounce their 
administration in even stronger terms than I have already 
used. I find it impossible to do so, however, and must 
content myself with the simple statement that their use 
is undoubtedly most strongly contra-indicated. 

If the obstruction is within comfortable reach, the 
veterinary surgeon should carefully knead it with the 
knuckles of his closed fist through the rectum, endea- 
vouring to crush it between his hand and the floor of the 
pelvis. It may, and does, cause pain, but it is also 
productive of good results. 

It goes without saying that, in addition to whatever 
treatment is being adopted, copious enemas should, at 
the same time, be freely indulged in. In fact, the ap- 
paratus for so doing should be left with the attendants if 
the veterinary surgeon is unable himself to frequently 


attend. The water should be used as hot as regard for 
IO 


146 THE COMMON COLICS OF THE HORSE 


the animal’s safety will allow, and with it should be 
included, at intervals, some good stimulating agent. 
Whether detached pieces of faeces come away with the 
ejected water or not, the rectal irrigation should be per- 
sisted in, and the attendants should be firmly impressed 
with the idea that it is the constant warmth that tends to 
do good. 

Should all these means prove futile and the case still 
linger on, the long rectum-tube of Smith should be 
passed into the gut and, if possible, while a stream of 
water is passing through it, inserted for the whole of its 
length. Itis important to keep a constant flow of water,’ 
at a fairly high pressure, through the tube, in order that 
it may find a ready and correct road. In case the tube 
should not be available, a similar length of garden-hose 
of suitable stiffness will answer tolerably well. The only 
drawback to the use of the rectal tube is the need of a 
forced water-supply. To those resident in a country 
district that obstacle to a correct. treatment is in most 
cases an insurmountable one—unless the animal is 
walked to the nearest market-town to the veterinary 
surgeon’s establishment. 

Finally, if all the efforts of the veterinary attendant 
are in vain, he may, if his position will bear the shock of 
a serious failure, and the age of the animal and its market 
value warrant him, talk to his client of operative measures. 
But of that more in a future chapter. 


Pane rEeR XII 


SUBACUTE OBSTRUCTION OF THE 
SMALL INTESTINES. 


Definition.—In spite of the fact that post-mortem 
records have not yet described a case of obstruction of 
the small intestines, I feel led, by the clinical evidence 
I have obtained, to give it, or at any rate the possibility 
of its occurrence, a place of description. Clinical evi- 
dence, as I hope this chapter will show, offers for our 
consideration a form of obstruction whose position in the 
intestinal tract is certainly far forward in the double 
colon. Whether further forward still, and obstructing 
the small intestines, only future records willshow. What 
evidence 7s obtainable appears to point strongly to the 
fact that obstruction of the duodenum does sometimes 
occur, and that ‘stoppage’ pains are not always to be 
precipitously referred to the single or doublecolon. The 
only argument against that statement is the one—‘ post 
mortem records have uot shown it.’ Purely negative evi- 
dence, however, is seldom really satisfactory ; and I hope 
that the symptoms hereafter described will substantiate 
my statement that obstruction of the small intestines, 
most probably of the duodenum, has sometimes to be 
reckoned with. 

Causes.—Regarding the causes of colic, I am afraid 

IOo—2 


148 THE COMMON COLICS OF THE HORSE 


that I have run almost to the end of my tether—or, rather 
have already enumerated them—and must again refer my 
readers to former chapters, allowing them to use their 
own discretion in each particular case as to which special 
_ causative factor they should give prominence to. Still, 
there are one or two circumstances that merit special 
mention. 

Foremost should come consideration of the duodenal 
S-trap. It is not hard to conceive of the possibility of 
this being a likely position for obstruction. Pressed, as 
it sometimes is, between the stomach and a distended 
colon, it would be remarkable if obstruction did not 
occur. Neither is it difficult to imagine that food im- 
perfectly masticated and passed on in a half-digested or 
acid condition from the stomach, and consequently unfit 
to be acted upon by the bile, should tend to stagnate in 
the duodenum. 

Following this, those morbid conditions of the liver 
that are instrumental in bringing about these disorders 
should be given attention. I, in common with many 
others, have noticed that prolonged feeding on rich 
nitrogenous foods will bring about a plethoric condition 
of the body that makes its first appreciable appearance in 
some disturbance of the liver functions. The animal 
becomes bilious. Congestion of the liver, or the 
diminished flow of bile from any cause, may, then, be put 
down as a factor in the production of duodenal obstruc- 
tion, for, with a lessened flow of bile, the digestion is 
imperfect, and a tendency to stasis is occasioned, 

Symptoms.—Almost invariably the pains that ac- 
company this disorder are those of an extremely dull 
type—even more dull than those that have already been 
described as dull pains. Pain of a degree there certainly 
is, but a certain amount of time must be given over to its 


SUBACUTE OBSTRUCTION OF SMALL INTESTINES 149 


consideration before it can be accurately traced to its 
correct source. | 

For some days prior to the exhibition of signs of un- 
easiness, the animal has been heavy, has not performed 
his work with activity and brightness, has appeared 
unusually dull and drowsy. When down he lies quiet 
for a considerable time, and only occasionally manifests 
the seat of trouble by a quiet look round at the flank. 
Rectal exploration reveals the presence of a few small, 
hard fecal lumps, which are abnormally dark in colour. 
The colon and such of the bowels as can be felt ave not ab- 
normally full, neither is there any undue fulness or tympany of 
the abdomen. The pulse is raised a little beyond the 
normal, and is firm and full to the fingers. The tem- 
perature shows slight signs of febrile disturbance, and 
the conjunctiva is plaimly stained a muddy yellow, more so, 
even, than is seen in that form of colic that is plainly 
referable to the great colon. The mouth is dry and 
sticky, and the odour of the breath abominably offensive, 
while the tongue and buccal mucous membranes are 
stained in like manner as the conjunctiva. 

It is not common, however, for the veterinary surgeon 
to be called in at this stage. When first he sees the 
case, the symptoms are more after this description : 

The pains have become a great deal more noticeable, 
but still remain under the category of ‘dull.’ The 
getting up and down has become more frequent, although 
fairly long intervals of ease are even now common. ‘The 
pain, when it does come on, is most intense just after the 
expulsion of a watery and extremely offensive purge, but 
rapidly subsides immediately after the first few minutes 
succeeding the evacuation. While the surgeon is watch- 
ing his case this purge may be repeated two or three 
times within the hour. 


150 THE COMMON COLICS OF THE HORSE 


Called in at this stage, the young practitioner, unless 
extremely wary, will be tempted to treat his case as one 
of simple diarrhcea, and administer astringents and 
sedatives. Needless to say, he commits a grave error. 
If, on the other hand, he is possessed of caution, and 
first explores per vectum, he will find a state of affairs 
there that does not fairly substantiate his first surmises. 
Certainly he will find the rectum, and probably also the 
single colon, with thew contents, in a fluid condition. In 
addition, however, he will discover other portions of the 
intestines stzll containing fecal matter in a state of solidity— 
proof positive that the purging has not been in existence 
for long, and equally positive proof that the purgation 
is not accountable for the dull pains that the carefully 
elicited history of the case has spoken of. Immediately 
on noting this, he will, if his clinical training be good, 
also observe that the pains the animal is showing are not 
of the kind that usually accompany the colic from exces- 
sive purging (see Chapter XVII.). There is not the 
tucked-up condition of the flank ; there is no excessive 
peristalsis on auscultation; there is no great alteration 
in the number of respirations nor their character, and the 
pulse is not in that weak and fluttering condition so 
commonly coexistent with colic from superpurgation. 
Neither will the animal show deswve fov the water offered 
him. 

This affords a suitable opportunity for mentioning a 
symptom, which, until now, has been carefully omitted. 
It is a well-known fact that the horse suffering from 
obstructive colic cannot, except in very rare cases, be 
persuaded to drink. In this particular instance it is 
almost proof that the animal is suffering from the pains 
of obstruction, and not those occasioned by an excessive purge. 
If it were the latter, he would be eagerly looking round 


SUBACUTE OBSTRUCTION OF SMALL INTESTINES 151 


on every rattle of a bucket, and, permitted, would drink 
to an alarming excess. 

If the veterinarian is of the same mind as myself, 
having decided that the purging is not directly account- 
able for the pains, he will refrain from giving the animal 
sedatives. ... He will treat the case purely as obstruc- 
tion, and persist in a solely stimulative treatment. 
Should he do so, he will, on his next visit to the case, 
have every reason to be delighted with his judgment. 
If it is his first case of this description, he will be quite 
anxious to learn whether or no the purging has stopped 
unaided. He is pleased to find that such is the case, and 
to hear that the animal has passed nothing for four, five, 
or six hours. 

Even now there may be an element of doubt, and the 
concerned thought is that the excreta is so thin as to be 
running through the bedding and so escaping notice. 

The dry tail does not point to it, and rectal exploration 
again settles the question. The interior of that bowel is 
quite dry, and sometimes contains chippy pieces of dried 
feeces. And still the animal is in pain—dull pain—still 
peristalsis is in abeyance. 

The veterinarian knows now by rectal exploration 
and the evidence of his senses (to wit, the sight of the 
purging) that the last portions of the intestines—the 
single and double colons—are comparatively empty. 
The stoppage or obstruction must lie further forward. 
It is not likely to be in the floating portion of the small 
intestines ; that he knows from post-mortem experience. 
It must, therefore, be situate in the duodenum, and the 
excessive biliary staining of the mucous membranes is 
now somewhat accounted for. Holding back from ad- 
ministering sedatives has left him in a position to treat 
his case on rational and not empirical lines. 


152 THE COMMON COLICS OF THE HORSE 


Correctly treated, the animal may begin to mend ina 
few hours, or the pains may last for as long as seven or 
eight days. Commonly it is only aday or two before the 
animal is, to all appearances, fully recovered. 

In every case I have yet seen the critical symptom ap- 
pears to be the voiding of a huge mass of feeces (clay-like, 
both in colour and consistence) from the anterior end of 
the intestinal tract. The offensive smell from this can only 
be fitly described as ‘disgusting.’ From that time on- 
ward the pains of obstruction vanish, and after a few days’ 
careful dieting and nursing, the animal is out of danger. 

Diagnosis.— Much of the matter under this heading is 
often but a reiteration of facts related under the symptoms. 
Little thus remains for the writer but to emphasize in 
brief such symptoms as he regards as diagnostic. 

Primarily, we must consider the long period of general 
dulness noticed by the attendants before skilled advice 
is sought; the comparative absence of fulness of the 
abdomen as revealed by rectal exploration, and the non- 
appearance of tympany; the biliary staining of the 
conjunctiva, and the clammy, fcetid condition of the 
mouth, with the yellowness of the buccal membranes. 
These may all be regarded more or less as premonitory 
diagnostic symptoms, and it is not until the more notice- 
able colic pains come on and the offensive purge 
commences that the veterinarian is able to fully satisfy 
himself as to the correct nature of his case. 

The character of the purge is doubtless due to want of 
sufficient bile in the intestines. The bile exerts certain 
antiseptic effects on the intestinal contents, and when it 
is withheld extreme foetor of the feecal matters is a con- 
sequence. Thus, the foetor may, to a certain extent, 
serve somewhat in locating the seat of trouble—may, in 
fact, in this case, be relied on as a diagnostic. 


SUBACUTE OBSTRUCTION OF SMALL INTESTINES 153 


When the purge has commenced, and the veterinary 
surgeon is able to accurately judge that this purge is not 
the actual cause of the colic, it is time he looked round 
for some other explanation of the pains. When, later, 
the purge ceases in a natural manner, without medicinal 
help, and the pains still remain in continuance, it is a 
fairly reasonabie conclusion that obstruction, in some 
position or other, is still to be looked for. 

The emptiness of the abdomen generally and the 
absence of tympany compel the veterinarian to place it 
far forward, and, admitting the fact that it is unlikely to 
be in the floating coils of small intestines in the left 
flank, the diagnosis, so far as we are yet able to settle 
it, is complete. We have summed up our case, and 
‘duodenal obstruction,’ with congestion of the liver as 
a primary cause or after-complication, is the verdict. 

Prognosis.—I cannot say that my experience of these 
cases leads me to regard them at all unfavourably. They 
may, as I have before stated, linger on for several days, 
but never during that time do they offer alarming 
symptoms. One visits the case every four or six hours, 
or, should it prove protracted, twice daily, and each 
examination reveals the animal strong and the pulse 
- good. The only untoward symptom of any gravity— 
one which I have never yet seen—would be a steady 
continuance and increase in the purgation. This being 
the case, the owner may, with every safety, be assured 
of a favourable issue. 

Treatment.—Broadly speaking, the treatment of this 
disorder must be conducted in two ways: Firstly, the | 
obstruction in the intestine should be removed ; secondly, 
such medicines should be administered as will bring the 
liver to a healthy and normal condition, and so prevent a 
recurrence of the attack. 


154 THE COMMON COLICS OF THE HORSE 


Those who have carefully read the preceding portions 
of this book will see no great difficulty in carrying out 
the first of these directions. Again, I do not advise the 
administration of aloes; at any rate, not as a dependable 
agent. The mere fact of the bile being thrown back in 
sufficient quantities into the blood-stream to stain the 
visible mucous membranes is ample evidence that it will 
not be found freely enough in the duodenum to assist in 
the solution of the administered aloes. Assuming that 
the obstruction has set up such inflammatory changes as 
to cause a diphtheritic closure of the bile-duct, and that 
there is collected bile in the intestine, should calomel be 
given in order to hasten its expulsion? I am of the 
opinion that no great amount of good is to be derived 
from that, unless the system is at the same time helped 
by suitable stimulant treatment in order to first remove 
the obstruction. 

That statement brings us back again to the ammonium 
compounds as our sheet-anchor—again advantageously 
combined with nux vomica or other nerve stimulants. 
Consequently, for the treatment I may, with one excep- 
tion, refer the reader to that advised for obstruction of 
the double colon. The exception is the hypodermic 
injection of eserine. I do not believe, in this particular 
form of colic, its administration is called for. At any 
rate, any idea of using it may be safely postponed until 
the case has been treated on other lines for some few days. 

Once more, I earnestly caution the practitioner to 
avoid sedatives. Even when the purging breaks out he 
should still persist in a solely stimulative treatment, for 
it is not until the obstructive mass in the duodenum is 
removed that he may regard his case as out of danger. 

When, after the period of purgation (which always 
seems to accompany these cases), the physician has once 


SUBACUTE OBSTRUCTION OF SMALL INTESTINES 155 


obtained a normal action of the bowels, he may continue 
with calomel in small doses to clear the intestine of the 
accumulated bile. He should, at the same time, put the 
animal upon a course of such medicines as are known to 
favourably influence liver functions, and so increase the 
bile secretion. 

Probably the most suitable remedy in this case is one 
of the mineral acids. Before reaching the circulation, 
acids must pass through the liver, where they appear to set 
free biliary acids, and stimulate expulsion of bile from 
the liver and gall-bladder.! The acid to be preferred is 
nitric or nitro-hydrochloric, and the following draught 
should be administered twice daily for three or four days: 


kK. Acidi nitrici dil. ° e ° - Bi. 
Aquam - . - - 2 - ad Oi. 
Misce; fiat haust. 


Should the practitioner decide not to administer the 
acid, he may, now that the obstruction is removed, 
employ aloes with advantage. Prescribed in 1-drachm 
doses once daily for three or four days, combined with 
ginger, gentian, or other vegetable tonics, it will exert a 
mild cathartic action, removing the bile from the intes- 
tines and stimulating the liver into activity. 

These attacks of duodenal obstruction, when the liver 
is to any great extent implicated, appear always to leave 
the animal in a state of great weakness and prostration— 
perhaps better described as want of tone and general 
lassitude. An easily digested diet is therefore called for, 
and the animal should be treated as convalescent for 
some considerable time. The simpler the diet, the 
better — bran with a few crushed oats and a liberal 
supply of good hay being all-sufficient. What water he 


' Veterinary Medicines’ (Finlay Dun), p. 178. 


156 THE COMMON COLICS OF THE HORSE 


has should be medicated with 2 or 3 ounce doses 
of magnesium sulphate, and the kidneys may be induced 
to carry off their share of the accumulated effete 
materials by judicious doses of potassium nitrate, either 
in the drinking water or the patient’s food. 

This chapter I will conclude with a very brief account 
of two cases, which will serve to illustrate what I have 
already written. In their description I do not intend 
giving a daily account of the symptoms; that would 
take up much of my space to but little advantage. The 
reader will have read the symptoms of this disorder for 
himself, and will understand that my relation of them 
has been based upon these and other similar cases. 
Consequently, a daily record of the symptoms would be 
but the most fulsome repetition. 


CASE. NG-an 


January 30, 1902, 3.30 p.m.—The subject of this case 
was a five-years-old cart mare (barren). I attended the 
owner’s farm, some five miles distant, and received a 
history of general dull pains spread over the previous" 
day. The pains had appeared somewhat worse (never 
violent) during the morning of this day, and were accom- 
panied several times by a nasty purge. This had led the 
owner to send for me. The pains the mare was showing 
did not appear to be proceeding from purgation; they 
were rather the ordinary dull pains of obstruction that | 
have mentioned so often throughout this book. 

To make assurance doubly sure I exploréd the rectum, 
and found that bowel containing a quantity of dirty liquid 
faeces, the odour of which was offensive in the extreme. 
Shortly after this manipulation the mare again volun- 
tarily evacuated a large quantity. As, however, I was 
unable to detect the usual symptoms of superpurgation 
(see Chapter XVII.), I diagnosed the case as one of ob- 
struction, and proceeded to treat it on those lines. I there- 
upon administered the balls and drench as advocated in 


SUBACUTE OBSTRUCTION OF SMALL INTESTINES 157 


Chapter IX., pp. 104 and 105, and left draughts con- 
taining diffusible stimulants for after admunistration, 
requesting the owner to let me know on the following 
day if the pains had not ceased. 

January 31, 3.30 f.m.—My attendance was again re- 
quested, and I found the mare exhibiting much the same 
symptoms as on the previous day, with the exception 
- that the purging had ceased since early the evening 
before. Accordingly, I repeated the stimulant treatment, 
and left further medicines of a similar nature. The case 
was showing no extreme urgency, and I did not propose 
seeing it again until the following day. 

February 1, 10.30 a.m.—The pains had now ceased, 
and the mare inclined to pick daintily at a little hay. 
The critical discharge of a mass of clay-like, offensive- 
smelling feces had taken place. I still continued the 
frequent administration of stimulants, now in smaller 
doses and combined with vegetable bitters and tonics, 
leaving these to be given by the farm attendants. 

February 2.—No visit. 

February 3.—Mare still convalescent, but doing well. | 
Had several times passed normal-sized heaps of faces, 
healthy in colour and smell, and was now feeding fairly 
well. Advised the continuance of the tonics and a few 

days’ rest. ‘The case subsequently did well. 


Case No. “4 


This case, one of the most remarkable in my experi- 
ence, was treated some eighteen miles from home. It is 
astonishing to me as showing the length of time it is 
possible for a horse to suffer from the pains of obstruc- 
tion and then recover. I need hardly say that it is one 
of those exceptions that go to prove the rule. 

February 21, 1900, 12 noon.—The subject was a six: 
years-old cart gelding. The owner, a client of mine, 
came and informed me that he had a horse ill at M : 
I had never attended there before on account of the 
distance, but was persuaded in this instance, as the owner 
urged that the atimal was a valuable one, that he was 
not satisfied with the treatment the horse was receiv- 


158 THE COMMON COLICS OF THE HORSE 


ing, and that he was unable to procure skilled advice 
nearer. 

On my arrival I found that the animal was being 
attended by one of the quacks of the old school, and 
gathered that he had been suffering from the ordinary 
pains of colic for some three or four days prior to my 
being called in. I could not gain much information from 
the empiric himself, but learned that he had been ad- 
ministering sedatives and aloes. 

I immediately insisted on having sole charge of the 
case, and commenced a vigorous stimulative treatment. 
I knew that, in addition to the obstruction, I had to fight 
against previously administered sedatives, and determined 
to run the risk of creating superpurgation by actively 
inciting the aloes to action. Accordingly, I administered 
in the form of balls the usual quantities of ammonium 
carbonate and nux vomica, in I and 2 ounce doses 
respectively, and the oil of turpentine and aromatic 
spirits of ammonia in 1-ounce doses, with linseed-oil as a 
draught. That done, I left the man in charge of the 
nursing with sufficient balls of ammonium carbonate 
and vegetable tonics to carry him on until the following 
day. : 

Ea nee 22, 9.30 a.m.—The administered stimulants 
had had the effect of restarting the peristalsis that had 
been stayed by the sedatives, and the animal was now 
purging. Following a similar line of reasoning as is 
described under the section devoted to diagnosis, I was 
able to ascertain that, in spite of the purging, obstruc- 
tion was still present, and persisted in the exhibition of 
ammonium carbonate and stomachic tonics, together 
with draughts of ol. lini, ol. tereb., and spt. eth. meth. 

February 22, 6.15 a.m.—Save that the purging had now 
stopped, the animal was in much the same condition as 
in the morning, and, after administering the usual balls 
and draughts, I injected 2 grains of eserine sulphate 
under the skin of the neck. Beyond putting the animal 
in a little more pain, its action was unnoticeable. 

February 23, 9.30 a.m.—Seeing that there was still no 
action of the bowels, I again administered the usual 
draught and six of the ammonium carbonate balls, after 


SUBACUTE OBSTRUCTION OF SMALL INTESTINES 159 


which IJ ventured on a further hypodermic dose of eserine 
sulphate. It was again unproductive of good, and I now 
decided to use it no more upon this particular animal, 
but to maintain a regular administration of such stimu- 
lants as could readily be given per orem. 

February 23, 6.15 p.m.—There was still no alteration in 
the symptoms, save that the animal had been induced to 
drink a little thin linseed tea. With no alteration of im- 
portance the stimulative treatment was continued. 

February 24, 9.30 a.m.—The case, to all appearances, 
was in the same condition as when left the evening 
previous. The same treatment was continued. Tiring 
somewhat of the case, being so far from home, and the 
train service wretchedly bad, I decided to see it no more 
that day, but left the man in charge a full supply of 
medicine, with instructions to desist in their administra- 
tion should the animal turn easier and attempt to eat. 

February 25 (Sunday).—No service of trains. Decided 
to leave the case unseen until the Monday morning. 

February 26, 9.30 a.m.—Animal weak, but recovered 
and free from pain. Feeding delicately. Appears to 
have suffered eight months rather than eight days. On 
the Sunday he had passed the usual mass of offensive 
dung, which had been saved for my inspection. Save 
the careful nursing and dieting the animal caused no 
further anxiety, and made an uninterrupted recovery. 

I have described this case with extreme briefness. 
Lest he should miss the point, I wish the reader to 
clearly understand that, at intervals of about every six 
hours, the horse received 2-ounce doses of ammonium 
carbonate for the whole of the four days I attended him, 
to say nothing of the frequent administration of draughts 
containing ol. tereb., spt. ammon. aromat., or spt. eth. 
meth., as my judgment led me. What the termination 
of the case would have been had the old empiric’s sedative 
treatment been continued I leave my reader to judge for 
himself. 


This concludes my somewhat lengthy description of 
the intestinal obstructions. Imperfect as I yet feel it to 


160 THE COMMON COLICS OF THE HORSE 


be, I hope I have now written enough to lead other 
observers to the more exact differentiation and diagnosis 
of these troublesome disorders. I also hope that the 
foregoing descriptions will have justified me in daring to 
thus arbitrarily subdivide and suggest new names for the 
time-honoured (yet, I venture to affirm, out-of-date) title 
‘Impaction of the Bowels.’ 


Pao ieR Xitl 


INTESTINAL IRRIGATION IN OBSTRUC: 
TIONS OF THE COLON 


Tue subject of pey anum irrigation of the intestines is 
of such great importance as to merit further description 
than the bare mention in Chapters X. and XI. _ Par- 
ticularly in the subacute varieties of colic I have been 
describing will it be found of value. Needless to say, it 
is obstructions of the colon that will be best benefited by 
its use. I am not referring simply to the passing into 
the rectum of a few pints of water with the ordinary 
enema syringe, but the injecting of several gallons by 
means of a forced water-supply, and a tube that may be 
inserted for at least 4 to6feet. It is again to General F. 
Smith that we are indebted for this further addition to 
our knowledge. 

Once or twice in this volume I have referred to im- 
pacted coils of intestine being found in the pelvis. 
Whether the obstruction be in the small colon or the 
large, I have no hesitation whatever in saying that 
forcible irrigation of the intestines with large quantities 
of water will do more than anything else to save the 
patient’s life. 

If the obstruction is in the small or single colon the 


impacted mass is comparatively small in size, usually 
II 


162 THE COMMON COLICS OF THE HORSE 


about the diameter of a large cocoanut (see Fig. 11). 
Should the obstruction be in the large colon, its relatively 
larger size at once denotes that fact. When felt through 
the rectum, it gives to the hand the impression of a huge 
foetus forced close to the pelvic outlet. Unless soon 
relieved, cases of this description quickly put the im- 
plicated portion of bowel into a state of obstinate 
paralysis. 

That being so, if the usual stimulative treatment fails 
to give early good results, intestinal irrigation should be 
at once commenced, Only one or two trials will con- 
vince the operator of the great value of the treatment. 

The only apparatus really necessary is several yards 
of ordinary rubber garden-hose of about 4 to $ inch 
in diameter, fixed to a forced water-supply. My own 
method of procedure, however, I will leave for the time. 
So far as I am able to trace, General Smith was 
the originator of this treatment, and that behoves 
me to give his case prior place. It is reported 
in the Pvoceedings of the Fifth General Meeting 
of the National Veterinary Association, and runs as 
follows : 


‘F. 54, 12th Royal Lancers, a grey gelding, five years 
old, was admitted at 4 p.m. on April 26, suffering acute 
abdominal pain. He threw himself down with great 
force twice before means could be taken to prevent it, 
and to avoid a rupture of the stomach or intestines I 
placed him in slings, or, rather, attempted to, for he no 
sooner felt the sling under him than he lay like a log in 
it. He was lowered carefully to the ground, and quickly 
hobbled, and a great source of anxiety was at once 
removed. Before I saw him he had passed a quantity 
of loose feeces, and the usual medicine had been ad- 
ministered, but he was getting worse. ‘The pulse was 
quick and small, respiration greatly increased, con- 
junctiva injected. Examination pey vectum revealed 


INTESTINAL IRRIGATION 163 


nothing. I at once gave morphia grs. viil. subcu- 
taneously, and administered aloes 3v. in_ solution ; 
applied mustard to the belly, and ordered copious 
enemata every hour at least. He was quiet for fully 
half an hour after the morphia, and at 9.30 p.m. I 
considered I might let him rise with safety. He was 
still in pain, but not so acutely, was kept on his legs, 
hot rugs applied to the abdomen, and mustard to the 
legs, as they were cold. His pulse was 60, soft and com- 
pressible; respiration 34; temperature 102°6°; conjunc- 
tiva injected. He remained in pain all night. 

‘ Apnl 27.—Delirious, head continually going to and 
fro, eyes more injected; pulse 60, very weak; respira- 
tion 40; temperature 103°; still in pain, has passed 
urine, a little flatus, but no action of the bowels; on 
rectal examination these are found distended with gas; 
continue the enemata, repeat the morphia, and constant 
application of hot rugs. ‘Towards mid-day, the morphia 
not having the least effect, I administered ext. cannabis 
indice 3i., and this kept him quiet for a few hours. 

‘ Evening.—Looks very wild, eyes glaring, continually 
throwing his head up and down and from side to side, 
wants to walk round the box; pulse 48, temperature 103°; 
12 p.m., still in pain, repeat the Indian hemp, and give 
ol. lini. Oi. ; hot rugs to abdomen all night, and the usual 
enemata. 

‘Apnl 28, 4 a.m.—In great pain, nothing passed ; in- 
jected morphia grs. vill. 6a.m.: The last dose of morphia 
had no effect, temperature 105°6°, pulse almost impercep- 
tible, conjunctiva scarlet and spotted, respiration 20, 
very delirious and suffering great pain. Io a.m.: Gave 
morphia grs. xvi., it had not the least effect, wandering 
continuously, head to and fro, passed a few small pieces 
of feeces, and strains. The case is most serious, and the 
horse will certainly die of pain, if he does not from the 
impacted colon. He got worse during the day, and at 
5 p.m. I gave him ext. cannabis indice 3ii., ol. lini. Oil. 
The hemp had, as usual, an immediate and lasting effect ; 
he stood quietly with his head between his fore-legs for 
two or three hours. The enemata administered with 
the ordinary pipe | considered so utterly useless, and 

II—2 


164 THE COMMON COLICS OF THE HORSE 


feeling certain that the impaction was in the colon and 
only required to be reached, I passed my long rectum 
tube (kindly made for me by Messrs. Arnold and Son). 
I first passed it up about 4 feet, and threw in about 
27 gallons of cold water—3 or 4 gallons of this remained 
in; what was rejected brought away a few small pieces 
of feces. 11 p.m.: There is great dulness over the 
double colon at the epigastrium, and also in the left 
hypochondrium ; I believe it is in these portions where 
the obstruction exists; I again passed the long tube, this 
time 6 feet, and threw up several more gallons of cold 
water—a large amount of this was retained. He was 
kept thoroughly under the influence of the hemp, pawed 
occasionally, still off his head, but much quieter. 

‘Apnl 29, 5 a.m.—Passed the long rectum tube to its 
full extent—6 feet—into the bowels, and threw in 
13 gallons of cold water, which were retained for a long 
time. The horse is quieter, temperature 102°, pulse 
stronger, but very quick, about 60; the conjunctiva is 
clearer; the dull sound of the epigastrium and left 
hypochondrium is considerable, but a welcome loud 
gurgling is heard. 11.30 a.m.: Repeated the enema with 
the long tube; slobbering from the mouth, and so weak 
that he has to stand with all his legs apart; the pain 
suffered is insignificant. 5 p.m.: Repeated the enema; 
temperature 100°, pulse stronger, conjunctiva clearer ; am 
very pleased with his appearance, and confidently expect 
his bowels to act shortly ; give, however, ol. ricini. Oli. 
Stood quiet all night. The delirium entirely disappeared. 

April 30, 4 a.m.—Repeated the enema; straining 
greatly, but passed nothing. 6 a.m.: Passage at last 
effected ; passed a large quantity of faeces, mixed with 
sand, gravel, and stones; temperature 100°. During the 
day took a bran mash ; passed more feeces, with gravel and 
sand, mid-day and evening. Evening: Pulse fuller, eye 
brighter, removed to another box and walked very tottery. . 


‘The record of this case need not be continued, for 
from this time he did well; he passed the gravel for a few 
days, and it then ceased; he lost so much flesh through 


INTESTINAL IRRIGATION 165 


his few days of intense suffering that it took two months’ 
nursing to replace. 

‘The interest in this case is centred in the long rectum 
tube. From a considerable experience in bowel com- 
plaints, I came to the conclusion some time ago that if I 
could throw an enema into the colon I would accomplish 
two objects: (1) Would act directly on an obstruction 
seated far forward, and (2) would place the enema 
beyond the expelling powers of the patient, and so enable 
the water to act mechanically on the contents of the 
bowel, and also restore the tone of the gut. I accord- 
ingly sent to Messrs. Arnold a description of the tube I 
required ; it was to be 6 feet in length, made of gum 
elastic, the same calibre as the ordinary Read’s enema 
tubing, and was to fasten on to this tubing when the 
ordinary wooden nozzle was unscrewed ; its extremity 
was to be round and perforated. Messrs. Arnold sent 
me the exact article, which I have no hesitation in say- 
ing saved the life of the horse whose case I have just 
detailed. There is no difficulty in passing it; having 
been well oiled, with gentle pressure it finds its way 
along the course of the rectum, and when it refuses 
to go further no force should be used; all that is 
required, should it be necessary to pass it further for- 
ward, is to pump in a gallon or so of water, which 
dilates the bowel in front of it, and the passage is accom- 
plished. It is fair to state that I have had cases where I 
could not get more than half that distance up, probably 
owing to an irritable condition of the gut, but even 
in these there is an immense advantage gained over the 
ordinary wooden nozzle, which is only put in for a few 
inches. I have constantly made experiments with the 
ordinary apparatus on the dead subject in an erect 
attitude, and find that with it no enema can go moie 


166 - TFHE COMMON COLICS OF THE Horse 


than 4 or 5 feet into the rectum, so that for obstruction 
in the colon it is useless) My long tube throws an 
enema with ease into the single colon, and probably into 
the double one. If while the enema is being given the 
ear be applied to the left flank, the water may be heard 
rushing along the intestine. The tube only requires to 
be used in a case of obstinate obstruction from gravel, 
faeces, etc., to prove its great value. Before I was 
supplied with the instrument I now possess, I used asa 
substitute the tubing that is found on Read’s enema 
syringe, removing, of course, the wooden nozzle.’ 

Thus runs Colonel Smith’s report of his case. Two 
facts in it I wish to point out to the reader: First, the 
apparent uselessness of large doses of sedatives to 
thoroughly allay pain in a serious case of obstruction, 
and the evident increase in alarming symptoms they give 
rise to. Secondly, the almost immediate effect of the 
cold water irrigation in reducing the temperature. 

I was led myself to adopt this treatment as a result of 
the experience of a fatal case of obstruction of the single 
colon that occurred in my own practice. In brief, the 
case was this: 


June 10, 6 p.m.—I was called to attend a six-years-old 
gray cart mare suffering from colic. I found her showing 
all the usual symptoms of impacted colon, and was con- 
firmed in my opinion by finding a distinct impaction in 
the pelvis. As is my usual practice, I gave four balls 
containing ammonium carbonate and nux vomica, and 
administered a draught of ol. lini. Oi., ol. tereb. and spt. 
ammon. ar., of each 3ii. Beyond the fact of finding the 
impacted coil of intestine in the pelvis, I was unable to 
detect any alarming symptoms. ‘The pulse was good 
and the pains not excessively violent. After watching 
her for some time, I injected hypodermically 1 grain of 
eserine sulphate, and left her for a few hours. 

10.30 p.m. — The symptoms showed no abatement 


INTESTINAL IRRIGATION ~i 267 


The eserine had failed to act. The pulse was slightly 
quicker, and the impacted intestine in the pelvis still 
present. I again repeated the ammonium carbonate 
balls, minus the nux vomica, and administered a further 
pint of oil. At the same time I injected copious warm 
enemas, medicated with soap liniment. 

June 11, 7.a.m.—I was disappointed to find that the 
case showed no improvement. ‘The pulse had risen to 
80, and the mucous membranes were becoming injected. 
No ease had been shown since my last visit. The case 
was undoubtedly becoming worse. I again repeated the 
balls and stimulating enemas, and injected a further dose 
of eserine. 

12 noon.—The eserine had again failed to act, and all 
the symptoms were becoming gradually aggravated. 
There were constant straining efforts to defecate, and 
enemas were quickly expelled, as clear as when injected. 
In my own mind I recognised a dying case, though I 
still persisted in giving stimulants and oil. 

10.30 ~.m.—Animal gradually succumbing. I had 
now reached the end of my tether, and, more as a forlorn 
hope than in any other spirit, I injected a further and 
larger dose of eserine—this time 2 grains. I gave 
the owner a fatal prognosis, and promised to call again 
in the morning. 

June 12, 7 a.m.—The case had slowly gone from bad to 
worse, and the mare was now evidently dying. No 
further treatment was attempted, and the animal expired 
some time shortly after noon. I made arrangements 
with the owner for a post-mortem to be held the 
same day. 


Autopsy.— The knowledge gained from this was 
simple enough, though painful in the extreme. Every 
portion of the intestinal tract appeared healthy. In no 
part could be found feces of more than a semi-solid 
consistence — save, of course, the impacted portion— 
neither were the bowel contents abnormally excessive. 
The impacted intestine was quickly withdrawn from the 
pelvis, and turned out to be a portion of the single colon, 


168 THE COMMON COLICS OF THE HORSE 


distant some 7 or 8 feet from the anus, The obstruction 
was nearly round, approaching the oval, about the size 
of a cocoanut, and, seeing that it was composed entirely 
of dung, extremely hard. It presented the appearance 
depicted in the accompanying photograph: 


Fic. 11.—IMPACTED PORTION OF SMALL COLON SUSPENDED BY 
MESENTERY. 


A, mesentery ; B, the obstruction ; C, sacculated folds of 
intestine ; D, longitudinal band of intestine. 


No other suspicious circumstance was present. The 
case was clear enough both to myself and the bystanders. 
Except for a few bright red patches quite near to the 
obstruction, the coats of the intestine were clear and 
clean. 

Remarks.—I need hardly explain to the reader how 


INTESTINAL IRRIGATION 169 


annoyed I was that the impaction was so small. In 
every probability, had the mare been operated on during 
the first day’s illness and the obstruction removed, she 
would have lived. . Still more probable would her 
recovery have been if constant intestinal irrigation had 
been persisted in. The fatal obstruction was actually 
within veach of a tube that could have been passed a 
few feet. 

Had I given aloes, would the issue have been different ? 
I cannot whip myself with the thought that it would. 
Against the argument that aloes would have moved the 
obstruction is the fact that the contents of the whole of 
the intestines in front of the stoppage were in a semi- 
fluid state. We had, in fact, by using the oil and the 
nux vomica, created a purge actually washing the surface 
of the obstructing lump. My only regret is that I did 
not then know the value of the long rectal tube and 
a bountiful supply of water. 

The next case, the first in which I adopted intestinal 
irrigation, was followed by recovery : 


History.— The patient was an aged black cart gelding, 
used for heavy hauling purposes—coal carting. He had 
been at his usual work all the week until late on the 
Saturday afternoon. He ate his usual feeds on Sunday 
morning and at noon, and was found in pain about 
6 p.m., when the men went to give the evening meal. 

Sunday, 6.30 p.m.—I found him exhibiting the following 
symptoms: Pain slight, but constant, and manifested by 
a ceaseless pawing with one fore-limb. Pulse about 68, 
but inclined to be fluttering and weak. He had pre- 
viously been rolling, but now showed no inclination to 
do so. Circumstances did not permit of a rectal examina- 
tion. So far as could be gathered from the appearance 
of the abdomen, there was no trouble in the large 
intestine. ‘That was surmised from the complete absence 
of tympanites. Diagnosis was withheld until a recta] 


=f? THE COMMON COLICS OF THE HORSE 


examination had been made. I administered the usual 
balls of stimulants, but was quite unable to get a draught 
down him. Left word with the owner to send him up to 
my own stables if he did not get easier before 9 p.m. 

9 p.m.—He was admitted into the infirmary and the 
rectum explored. My former surmise was wrong, for 
a huge mass of intensely impacted intestine—evidently 
the large colon—was found forcing itself right into the 
pelvis within 6 inches of the anus. I again repeated 
the balls, and failing, owing to his awkwardness, to 
administer a drench, gave a warm enema, containing a 
large quantity of turpentine liniment, in the hope that 
some of the turpentine would become absorbed, and so 
excite the bowel to action. The pulse still maintained 
the same number of beats, but had improved somewhat 
intone. Asthe animal was now lying down, and appeared 
fairly comfortable, I decided to let him remain until the 
morning before attempting further measures. 

Monday, 7 a.m.—FPatient still in the same condition. 
Administered hypodermically 14 grains of eserine sul- 
phate. ‘This put him in slightly more pain for about an 
hour, after which he again grew easier. During the 
hour he passed a few small quantities of feces. This 
I judged was only from the single colon, for rectal 
exploration still revealed the presence of the impacted 
coil of larger intestine. 

12 Noon.—Still failing to induce him to take my usual 
doses of linseed oil, I had no other alternative but to fall 
back on aloes. I administered 3 drachms only. The 
torpid condition of the bowels, however, promised little 
hope of its acting; that being so, I decided to irrigate 
the colon with cold water. 

4. p.m.—Connected the hose with the ordinary town 
water-supply, and forced into the intestines per vectum 
several gallons of cold water. I found it impossible to 
estimate the exact quantity, for during the first few 
minutes of passing the tube there was a fairly constant 
flow of water outwards from the rectum; then, as the 
bowel in front of the injecting-tube expanded owing to 
the pressure of the water, and the tube found its way 
further in, the flow from the rectum partially ceased, 


INTESTINAL IRRIGATION 171 


until the quantity being injected must have far exceeded 
that dribbling out. At this period of the injecting, the 
ear applied to the left flank could plainly hear the water 
running in. What was more pleasing still to hear was 
a loud rumbling and disturbance of the intestines, 

After keeping the stream going for about ten minutes, 
during which time several gallons must have found a 
way into the colon, the tube was withdrawn. Beyond 
a slight shivering of the haunches, no ill effects were 
noticed. Indeed, the reverse was the case, for the pulse 
dropped to near the normal in number, and gained 
decidedly in tone. The animal appeared more cheerful, 
and even partook of a small feed. After doing so, he 
again showed dull pains, but the general condition was 
distinctly improving. 

The quantity of water injected could now better be 
estimated by the frequent evacuations made by the 
animal. From the time of the injection at four o’clock 
until as late as six or seven he passed out at frequent 
intervals a stream of water. At first this came away 
quite clear; later it was stained a muddy yellow; later 
still there came with it long strings of pale yellow mucus 
and choppy pieces of ingesta. Nothing further was done 
with the animal that night. 

Tuesday, 10 a.m.—Animal still showing dull pains. A 
rectal examination was again made. Even now, after 
the lapse of seventeen or eighteen hours, the rectum was 
found full of a feeces-stained fluid. The obstruction was 
still present, but perceptibly softer. ‘The irrigation was 
repeated in the same manner, and followed by the same 
results, 

4 p.m.— Patient decidedly easier. Repeated the irriga- 
tion, and administered a stimulant to promote warmth. 
The animal was then left for the night. 

Wednesday, 9 p.m.—Horse quite easy. He had eaten 
a good feed, and passed several heaps of faces of normal 
consistence. From this time he made an uninterrupted 
recovery. 


Remarks.—The striking feature in these cases is the 
impunity with which large quantities of cold water may 


(72 THE COMMON COLICS OF THE HORSE 


be injected without bad effects. As the foregoing case 
illustrates, it appears rather to be productive of good. 
The rise of febrile symptoms is effectually kept down, 
and the rectum is prevented from attaining that degree 
of horrible dryness that so commonly associates itself 
with this type of colic. If not directly reached by the 
in-running stream of water, the obstruction appears to 
become softened by the large amount of fluid remaining 
in the rectum immediately over it. 

In obstructive colics, occasioned by the accumulation 
of masses of undigested food, veterinarians have con- 
stantly bewailed the fact that the patient will not drink. 
Here is a ready means of pouring into his system the 
fluid he will not voluntarily take. In addition to the 
mechanical aid it gives, we have the welcome signs of 
active peristalsis, induced by the excitant action of the 
cold water on the intestine itself. Now that I know its 
value, it surprises me that no one seems largely to have 
adopted the treatment. It is not a great deal of trouble, 
and its beneficial results are at once apparent. 


fisor LER XIV 


THE SURGICAL TREATMENT OF 
INTESTINAL OBSTRUCTIONS 


AT times, in his treatment of colic, the veterinarian is on 
the horns of adilemma. He feels confident that he has 
successfully diagnosed intestinal obstruction of such a 
nature, and in such a position, as to render surgical 
interference reasonably warrantable. 

Should operative measures be advised early on in 
the case? Should expectant treatment be first adopted, 
and the operation be only advised as a devmer vessort ? 
If the first is decided on the patient may die from the 
effects of the operation, and the owner be accordingly 
annoyed. Adopting the latter procedure, the patient, in 
a state of rapid collapse, will not offer great possibilities 
of the operation being successful. 

Thinking so, the veterinarian has been apt to let 
matters rest, and it was not until 1895 that Professor 
Macqueen, of the Royal Veterinary College, put the 
matter upon a more satisfactory basis. This gentleman’s 
experiences, coupled with his exhaustive searches into 
veterinary literature, led him to the belief that penetra- 
tion of the equine peritoneal cavity was not so highly 
dangerous after all, and that operations involving that 
step were quite safely within the bounds of possibility. 


i74 THE COMMON COLICS OF THE HORSE 


For the benefit of his brother veterinarian, Professor 
Macqueen converted his beliefs into undeniable facts 
by the performance of several interesting experiments. 
Horses were cast and anesthetized. Suitable antiseptic 
precautions were taken, and in each case a small por- 
tion of the floating colon was exposed. An incision was 
made through the bowel wall, its contents removed, the 
wounds sutured, and the animal allowed to recover. 
Reserving my remarks on its practical utility for the end 
of the chapter, I will allow Professor Macqueen to give 
the details of this operation in his own words: 

‘Materials, instruments, etc., vequived.cFour large and 
twelve small Turkey sponges, for use inside the abdomen 
and about the bowel. ‘Twelve yards of tarlatan, cut into 
two-yard lengths, for packing round the bowel brought 
outside the wound. Four sponge cloths, for laying on 
abdomen and thighs to catch dust during the operation, 
to wipe the skin, and for rougher work outside the wound. 

‘Three enamelled iron trays to hold instruments, liga- 
tures, and needles. Four zinc pails to hold hot water, 
sponges, lotions, etc. One small bucket marked in pints 
to measure hot water for making solutions, etc. Some 
20 per cent. carbolic soap for washing hands and flank 
and for shaving. One aseptic scalpel and a razor. Two 
elbowed scissors, sharp and blunt pointed, to divide 
muscles, open peritoneum and bowel. Two sponge- 
holding forceps. Two Thornton’s T-shaped forceps to 
stop bleeding from skin or muscle. Two Wells’ catch 
forceps, and one or two spring and dressing forceps. 
A few straight and curved suture needles. Twenty 
milliners’ needles, straws No. 5, for stitching the gut. 
Chinese twist for all sutures—No. 1 for the gut, No. 3 
for muscles, and No. 6 for the skin. A fine trocar and 
cannula, to puncture, if necessary, distended bowel. A 


SURGICAL TREATMENT 175 


convenient supply of hot water, and a piece of fine 
muslin, several layers thick, for use as a sieve for water 
to be used for lotions or for irrigation. Chloroform and 
an inhaler with sponge, and some pure carbolic acid ina 
graduated bottle. For dressing the wound the following 
should be ready: Iodoform and tannin, 1 to 3; antiseptic 
cotton-wool and tow; carbolized gauze; a piece of 
calico, 6 yards by g inches; roller bandages, and a few 
safety-pins. 

‘ Prepavation.—The small sponges may be obtained 
ready for use from any wholesale druggist. They are 
known as Milne’s aseptic sponges. Probably the large 
sponges can be purchased in the same condition. | 
prepared my sponges in this way: After beating out the 
sand the sponges were placed for four or five days in 
cold water, which was changed daily, then transferred to 
a solution of hydrochloric acid, an ounce to the gallon, 
where they remained for twelve hours; from this they 
were placed under the cold-water tap, and turned about 
under a constant stream for an hour or two; then each 
was thoroughly washed in plenty of hot water, squeezed 
-as dry as possible, and finally placed in 5 per cent. 
carbolic solution. 

‘The tarlatan, cut into two-yard lengths, was washed in 
hot water containing Hudson’s powder, then thoroughly 
rinsed, and placed beside the sponges in carbolic. The 
sponge cloths were boiled, rinsed in cold water, soaked 
in 5 per cent. solution of carbolic, and then dried. 

‘The Chinese twist was stretched by winding each 
skein on a bit of wood (3 inches by 14 inches), plunged 
in hot water, and boiled for ten minutes; then stretched 
again by winding on another bit of wood, and finally 
placed in a wide-mouthed bottle containing 5 per cent. 
solution of carbolic acid. 


176 THE COMMON COLICS OF THE HORSE 


‘ The scissors, forceps, needles, scalpel, etc., should be 
kept together in a sheet-iron case, which may be placed 
on a stove or near a fire. 

‘After operation the sponges, instruments, etc., must 
be cleansed. The sponges and tarlatan are placed 
together in cold water, which is frequently changed ; 
then the sponges are transferred to hot water containing 
washing soda—4 ounces to the gallon—and left there 
for a day. From this they are placed under the cold- 
water tap, then washed separately in hot water, dried 
in the sun, divested of hairs, and again placed in 5 per 
-cent. carbolic. The tarlatan is washed as before with 
Hudson’s powder, dried, and placed beside the sponges, 
For keeping sponges and muslin a 2-gallon pail, with 
hinged lid, will be found very convenient. The sponge 
cloths, after soaking in water, are boiled with soda, 
rinsed, and dried. ‘The instruments are scrubbed and 
washed in hot water containing Hudson’s powder, dried, 
and enclosed in the iron case, which is then placed near 
a fire. 

‘ Preparation for Operation.— Before casting the horse, the 
flank from spine to groin and from haunch to sixteenth 
rib is clipped and washed. When the horse is under 
chloroform the flank, within 2 or 3 inches of the 
boundary marked by clipping, is shaved and disinfected. 
While these preliminaries are proceeding, the pails and 
trays are arranged and filled. All the solutions must be 
warm, and the water used in their preparation passed 
through muslin. Pail No.1 is filled with 5 per cent., 
and pail No. 2 with 24 per cent., solution of carbolic 
acid. The trays are filled with hot solution of the same 
strength as pail No. 2. The sponge cloths are placed in 
No. 1, and kept there until required. The sponges and 
tarlatan, after having been squeezed as dry as possible, 


SURGICAL TREATMENT 177 


are placed in No. 2. In one tray are placed the 
milliners’ needles, twelve of which are threaded with 
twist No. 1; another tray contains scissors, forceps, and 
scalpel; and the third contains reserve instruments, 
suture needles, and twists Nos. 3 and 6. Pail No. 3 is 

Position of first incision through the skin and 


acruss the fibres of the external oblique. 


TINY Fa 
* #3 .s A te 
BS SSS Merwin 
NS, CR eS 
nyxs- |} 


€ ) 
Cy ERR NS 
~ x 


MOR se & 
MEH 


<j TPT - 
Gy SOR SRO ee oe: ~ es “te 
‘ Petry tte Sos - Oty. %, 
ns 2 - Vest, a oe a 
rer eye ns Me. 
ee SA SR aT EE ENP ra: 0 


aioe 
SPELT C 


rhe 


TERPS AOI 
ae et: 
h : 
Si oe eeeiekG 
7 : ae uy 
= — , 


Dotted line marking the 
position of secondary 
wound for drainage. 


Fic. 12—SEAT oF LAPARO-ENTEROTOMY (MACQUEEN’S OPERATION). 


filled with hot water for rinsing hands and instruments ; 
and pail No. 4 is filled with boiling water, which is pro- 
tected from dust and allowed to cool. This water will 
be required to wash the bowel after suture. 

‘ Abdominal Incision.—The linea alba offers the least 


vascular and shortest route to the interior of the 
12 


178 THE COMMON COLICS OF THE HORSE 


abdomen. Through an incision of the white line any 
organ within the cavity can be felt, the small and large 
intestines in part can be seen, and to some extent 


Skin. 


= os Cut fibres of ex- 
eure ternal oblique. 


ie Second inciston 

parallel with 

the fibres of 

the internal 

oblique. (The 

fibres of the 

~  transversalis 

~ can be seen 

Cs) through the 
wound). 


4 


ane 


ba 
, ieee 


os 
Stig ar 
PG as 


vo 


Fibres of 
internal GS Te tt 
oblique. i A 


Fic. 13-—OPERATION WounD (LAPARO-ENTEROTOMY), 


Showing the first incision through the skin and across the fibres of 
the external oblique. (Enlarged from Fig. 12.) 


portions of these viscera can be withdrawn; but the 
colic mesentery is too short to permit the first part of 


SURGICAL TREATMENT 179 


the floating colon to pass through the wound. Besides, 
if the incision is made at this point the wound does not 
heal rapidly, and adhesion between its peritoneal surface 
and omentum or bowel is'a probable complication. In 
the horse, incision of the abdomen an inch or two to 
the right or left of the linea alba is equally objectionable. 
When the floating colon has to be opened, I prefer to reach 
the bowel through the flank (see Fig. 12, p. 177). In open- 
ing the flank I make three wounds before touching the 
peritoneum. The first divides the skin, fascia, and external 
oblique muscle; the second the znternal oblique; and the third 
the transversalis (see Fig. 13, p. 178). The first starts ata 
point 4 inches below the lumbar transverse processes, 
midway between the angie of the haunch and the last rib, 
and passes downwards and forwards for 7 or 8inches. The 
forward direction of this incision is opposed to all teaching, 
but its advantage is conceivable. The upper hind limb 
is unhobbled and drawn backwards. The wound gapes 
and exposes the internal oblique muscle, which is then 
cut with scissors in the direction of its fibres. A similar 
opening is made in the transversalis. The third wound 
exposes a layer of fat which is lined by peritoneum; this 
is pierced with the finger, and the opening is enlarged 
with scissors in the direction of the transversalis wound. 
‘Incision and Suture of the Bowel.—So far I have only 
opened the bowel at the middle of the longitudinal band, 
where the wall appears strongest and most capable of 
supporting sutures (see Fig. 14,p. 180). With sharp- 
pointed elbowed scissors the gut can be punctured and 
the wound extended without the slightest difficulty. The 
wound is closed with sutures of prepared Chinese twist 
No. 1. There are many methods of suturing bowel 
wounds, but Lembert’s is the only one of which I have 
experience. Sutures applied by Lembert’s method pass 
12—2 


180 THE COMMON COLICS OF THE HORSE 


through both the serous and muscular coats; the mucous 
membrane must not be punctured. The needle enters 
4+ inch from wound, passes through muscle for } inch, 
then pierces serous } inch from the edge of the wound. 
It is then carried across the wound, re-inserted } inch 
from edge, passed through muscle for 4 inch, and brought 
out + inch from the wound. A glance at the diagram 
(Fig.14) will enable anyone to understand the course of 


pile ar 
MET AD 
yee 

yet ee 


Fic. 14.—LEMBERT’S SUTURES (IN SMALL COLON). 


the needle. The sutures are placed 4 inch apart and 
tied separately. The ends are shortened to within } inch 
from the knots. Degive has improved this method by 
making the sutures continuous. 

‘ Opevation.—Cast the horse on the left side and give 
chloroform. Wash, shave, and disinfect the flank. 
Spread sponge-cloths, wrung out of carbolic lotion (5 per 
cent.), in front and behind area of incision, Incise skin 


SURGICAL TREATMENT 181 


and external oblique; unhobble upper hind limb, draw 
it backwards, and fix to a post or wall. Douche wound 
with warm carbolic lotion (24 per cent.), and stop bleed- 
ing from skin and muscle. With elbowed scissors slit 
internal oblique muscle in the direction of its fibres, trim 
the edges, and stop bleeding. Snip transversalis with 
scissors and extend opening with finger, taking care not 
to puncture fatty layer or peritoneum. Examine wound 
and check bleeding. Sponge with warm carbolic lotion 
(24 per cent.) and remove excess of fluid. When satis- 
fied that the wound is “dry,” rinse the hands, push 
the finger through fat and peritoneum, and enlarge 
opening with blunt-pointed elbowed scissors. Pass a 
large sponge, wrung out of (24 per cent.) warm carbolic 
solution, into abdomen, and get tarlatan ready. Pass the 
hand into abdomen, bring out the bowel, and hold it 
gently until assistant has placed pieces of tarlatan, 
moistened with warm carbolic lotion (24 per cent.), round 
the wound. This done, let the assistant take the bowel 
between his fingers applied like clamps, the hands resting 
one in front, the other behind the wound. Incline the 
bowel towards the horse’s thigh, and slit the free border 
with scissors. Remove contents and wash its mucous 
lining. With a fresh sponge clean the edges of the 
wound, and apply Lembert’s sutures. Place the stitches 
4 inch apart, and insert two or three beyond the 
wound at each extremity. Pass all the sutures before 
tying any. Wipe the edges as tying proceeds, and 
shorten the suture ends to } inch from the knot. 
When the wound has been closed, pull the bowel 
well out of abdomen, and let assistant renew his hold. 
Carefully sponge off clots, hairs, and suture ends, and 
douche with boiled water that has been allowed to cool 
to about 106° F. Remove packing from round the 


182 THE COMMON COLICS OF THE HORSE 


wound, let the bowel slip into abdomen, and withdraw 
the sponge. Look inside, and, if necessary, pass in a 
fresh sponge to take up clots or fluid. Adjust the edges 
of transversalis wound, and excise protruding fat. Pass 
two or three sutures (twist No. 3) through internal 
oblique muscle, and sponge the surface with carbolic 
lotion. Re-hobble upper hind limb, and bring edges of 
external oblique together with a few fine sutures. Close 
the external wound with strong (No. 6) twist sutures 
passed through skin and muscle, tied in front or behind 
the line of union. Then slit skin and fascia downwards 
and backwards to 2 inches from lower end of first 
incision. This will drain the operation wound. Sponge 
the surface with carbolic lotion, and let the horse rise. 
Dust the flank with iodoform and tannin, insert aseptic 
tow in drainage wound, and cover the whole with car- 
bolized cotton, protected with four layers of gauze. 
Support the dressing by winding calico round the body, 
and roller bandages secured with safety pins. Muzzle 
the horse for five or six hours, but leave his head loose. 
Encourage, but do not force, exercise. For a few days 
restrict his diet, which ought to be somewhat laxative. 
Dressings should not be renewed until oozing occurs, 
then re-dress, but do not plug the drainage wound. ‘The 
dressings might be substituted with advantage by pitch 
plaster or a mild blister.’ 

Following closely the lines advocated, Professor Mac- 
queen operated on (a) an aged brown pony gelding, 
(b) an eight-years-old chestnut pony gelding, and (c) an 
aged brown nag gelding, at one of which operations I 
had the good fortune to be present. 

So far as could be ascertained, these animals were 
healthy before the experiments. 

Animals (b) and (c) were allowed to live sufficiently 


SURGICAL TREATMENT 183 


long after the operations—twenty-two and thirty days 
respectively—to prove the success of the undertaking. 
They were then chloroformed to death, and post-mortem 
examinations made of the carcasses. In each case the 
result of the autopsy was gratifying. 

The brown pony gelding (a) was slaughtered on the 
seventh day following the experiment. If I remember 
rightly, he showed somewhat peculiar symptoms shortly 
after the operation. It was difficult, in fact, to say 
whether he was suffering .from an ordinary sporadic 
attack of pneumonia, or whether the pneumonia was of 
a septic nature, caused by absorption from the operation 
wounds. I think that I may say the result of the 
autopsy on the seventh day rather justified the assump- 
tion that the pneumonia was sporadic in its nature, and 
that the operation was not the cause of it. 

We have here three operations of a serious nature. 
The end result of one may be classified ‘ doubtful,’ with 
a leaning towards ‘ favourable’; while the remaining two 
may be termed in the highest degree ‘ successful.’ The 
surgeon has shown us that, so far as the operation itselt 
is concerned, we have nothing to dread. 

Can it be turned to practical account? One case only 
is on record of the operation being successfully performed 
for the removal of a calculus or obstruction that was 
actually giving rise to dangerous colic. This was by 
Felizet in 1849. The position of the calculus was the 
commencement of the small colon. Several other cases 
are on record where the same operation has been 
attempted, the animal, unfortunately, dying in each 
instance. It appears that in each case the failure of the 
operation was directly attributable to its having been too 
long delayed. 

Several years have now passed since Professor Mac- 


184 THE COMMON COLICS OF THE HORSE 


queen performed these experiments. Their practical 
utility can only be judged of by what has transpired. 
So far as I am able to trace, no successful removal of an 
obstruction with the complete recovery of the patient 
has since been placed on record. Either the present-day 
veterinary surgeon, in spite of Professor Macqueen’s 
able assurance of success, is not possessed of the bold- 
ness of the old-time Felizet, or he has deemed the 
operation not exactly ‘impossible,’ but ‘ inadvisable.’ 
I am loth to put the paucity of recorded cases down 
to apathy and want of boldness, and can only conclude 
that the veterinarian has not seen it practicable to put the 
operation into every-day use. 

The man who first diagnoses a suitable case, after- 
wards operates in good time, and is rewarded by the sub- 
sequent recovery of his patient, will have to be possessed 
of an amount of foresight and will-power far beyond the 
ordinary. 

In the first place, he will have to be able to decide 
quickly that the obstruction he is dealing with is not 
likely to surrender to milder measures—surely a difficult 
task. Again, he must be convinced that the percentage 
of deaths from obstruction of the single colon is heavy 
enough to warrant the operation being immediately 
advised in each and every case that is diagnosed. The 
equine patient does not live long enough with obstruction 
to allow of any delay, no matter how short. Untoward 
conditions in the bowel soon make their appearance, and 
place its wall in an unfit state for surgical interference. 
If the veterinarian waits until the symptoms frighten 
him into the operation, he has waited too long. Coupling 
this need for immediate decision with the fact that nearly 
all veterinary operations must be regulated by strictly 
economic principles, it is not surprising to learn that 


SURGICAL TREATMENT 185 


a major operation of this description—one for which a 
large fee must necessarily be demanded, and one which 
will make or mar a great deal of the operator’s 
reputation—is severely relegated to the background of 
‘possible,’ but ‘inadvisable,’ remedial measures in cases 
of equine intestinal obstruction. 

To my own mind there is only one of the intestinal 
obstructions described in this volume that is at all likely 
to warrant this extreme step being taken: that is the 
obstruction occurring inthe small colon. That con- 
clusion is fairly justified by the following considerations : 

1. Professor Macqueen has covertly admitted that the 
small colon is the most suitable bowel to operate upon, 
its comparatively thick longitudinal band offering a suit- 
able position for the incision and the after-placing of the 
sutures. 

2. In the present state of our knowledge, the diagnosis 
of these obstructions is not sufficiently clear to justify us 
in operating unless the obstruction has been positively 
felt per vectum. I have already shown, in Chapters X. 
and XI., that an obstruction of this size felt per vectum is 
most likely to be in the small colon. } 

3. Should the obstruction be demonstrated to exist in 
the large colon,.we have to face two serious factors 
largely operating against the chances of successful 
surgery: (a) The extreme likelihood of the obstruction 
being of so large a size as to necessitate a very large 
incision in the bowel wall. (d) The comparative thin- 
ness of the walls of this portion of the intestinal tract, 
which would render the placing of safe sutures a matter 
of considerable difficulty. 

When all is said, the veterinarian may remember this 
much with safety: Whatever may be his doubts con- 
cerning his diagnosis, whatever anyone else may urge to 


186 THE COMMON COLICS OF THE HORSE 


the contrary, he may be perfectly assured—thanks to 
Professor Macqueen—that the incising of the flank and 
opening of the bowel (laparo-enterotomy) is attended with 
no grave risk in the horse—that is, if conducted strictly 
under modern antiseptic precautions, and with a patient 
still free from symptoms of collapse. 

As illustrative of a suitable case for operative measures, 
I would refer the reader to a reported case of Mr. E. R. 
Harding, M.R.C.V.S., of Salisbury :} 


‘Peculiarly-shaped Large Calculus in the Small 
Colon of a Mare.—The mare was taken ill on a Sunday. 
An examination was made by Mr. Harding. The large 
bowels were found full of feeces, and the animal showing 
signs of colic. The pain was not acute, and the tem- 
perature very little disturbed. The animal was given 
2 grains of eserine without its having the slightest effect 
on the colic or in producing defecation. Aloes was not 
given, but the case treated with stimulants. During the 
first four days she had intervals of pain, while at other 
times she was quiet. At no time was the pain acute. 
After Tuesday the animal appeared to have no pain 
whatever for a week, but she ate nothing, and there was 
no movement of the bowels. The only medicine admin- 
isteved was stimulants,2 and warm-water injections five or 
six times a day. This went on for eighteen days, when 
the mare died during the night. A post-mortem revealed 
a large calculus in the colon, and showed that the actual 
cause of death was ruptured colon, while an enormous 
mass of ingesta was found in the bowels. The calculus 
was 34 pounds in weight, and seemed composed princi- 
pally of fecal matter. The animal had been in the 


owner’s possession four or five years, and had not been 
ill before.’ 


There are two things that appeal to one in the report 
of that case. The first is the marvellous manner in 


1 Veterinary Record, vol. xiv., p. 682, 
2 The italics are mine,-—H. C. R. 


SURGICAL TREATMENT 189 


which it points to the advantages of a solely stimulative 
treatment. It would be hard to imagine an animal with 
obstructive colic being dosed with sedatives and then 
lingering on in the. same manner for so long a time as 
eighteen days. The fact of the matter is this: The 


FIG. 15,—CALCULUS OBSTRUCTING SMALL CoLon (Mr. HarpIna’s 
Case). 


general abandonment of sedatives in veterinary equine 
practice would undoubtedly lead to the better diagnosis 
of colic troubles. I feel that it has already increased 
my Own powers in that respect, and what it will do for 
me it will do for others. 


188 THE COMMON COLICS Of ©THE HORSE 


Secondly, one is forcibly struck by the grand oppor- 
tunity this subject would have afforded for operative 
measures if only a successful diagnosis could have been 
made during life. 

I would fain hope that in this way the future success 
of laparo-enterotomy lies. It may be that a long series 
of colic cases treated without sedatives will eventually 
lead to a greater and more frequent exactness in the 
diagnosis of these obstructions; that being done, the 
operation will follow naturally. This cannot be expected 
until a solely stimulant treatment is adopted by a large 
number of veterinary surgeons, and the information 
derived from their cases carefully chronicled. 


SO APIEER XV 


INTESTINAL TYMPANY: WIND COLIC, 
FLATULENT COLIC, HOVEN, 
TYMPANITES, ETC. 


Definition.—That condition produced by the evolution 
of gases in abnormal amount in some part of the intes- 
tinal canal, with consequent over-distension of the portion 
in which it occurs. In the horse the common seats of 
tympany are the stomach and the large colon. The 
former we have already disposed of in a previous chapter, 
and it now remains to give a fuller consideration to this 
particular condition when confined to the intestines. 
Causes.— These I have already enumerated at length 
in Chapter VII. On that account, no mention here 
beyond a brief summary is necessary. Dietetic errors 
again come to the front. Probably the most common 
cause of all is the gorging with young herbage when the 
animal is first turned out in the spring after a winter 
in the stable. Young growing corn, clover, vetches, 
and foods excessively mouldy may all be regarded as 
dangerous. One of the worst cases I have encountered 
myself was brought about by the owner feeding the 
animal on raw potatoes. The use of new oats, wheat, 
and steeped foods that have been allowed to go sour, is 
alsoa common cause of this condition, Reports of cases 


190 THE COMMON COLICS OF THE HORSE 


also show this disorder to sometimes be occasioned by 
animals eating large quantities of mangolds, swede, 
turnips, or other roots. Putting to work too soon after 
a heavy meal, or watering and feeding too freely when 
exhausted, are also likely factors in its causation. 

A dangerous form of this derangement is often met 
with by those who live in marshy districts. The coarse 
grasses and succulent forms of herbage that flourish 
down by the water’s edge appear peculiarly liable to 
bring on an attack. When half dried, these marshy 
grasses seem even more dangerous still, and many a 
case of severe intestinal tympany is directly traceable 
to a meal of what is commonly known as ‘ dykeings ’"— 
heaps of partly-dried vegetation mown from close to the 
water-side during the process of cleaning the drain.1 

Williams, in his description of this complaint, says: 
‘Tympanites may arise independently of any cognizable 
extrinsic cause. Occurring during the process of another 
disease, it is always to be looked upon as indicative of 
a very grave condition, that the animal powers are 
so exhausted as to be bordering upon dissolution, and 
becoming amenable to chemical laws. Tympanites also 
occurs in obstructions of the intestinal canal from calculi, 
tumours, or other mechanical causes, and generally indi- 
cates the approach of death.”? 

Symptoms.—The veriest tyro cannot fail to appreciate 
at their true value the indications of abdominal tympany: 
As might be expected, the most prominent symptom is 
a manifest drum-like enlargement of the belly. The 
skin and abdominal muscles become enormously tense, 
and resonance is obtainable on percussion. In addition 

1 In the Fens ‘drain’ is simply another word for ‘dyke,’ or 


artificial water-course. In no way does it signify sewer.—H.C, R. 
2 ‘Principles and Practice of Veterinary Medicine,’ p. 555. 


INTESTINAL TYMPANY 19! 


to this, all the usual symptoms of ‘colic’ are well in 
evidence. The animal walks round and round, paws 
alternately with the fore-feet, and makes frantic kicks at 
_ the belly with the hind. 

In a mild case the tympany is plainly most noticeable 
in the right flank. When, however, the abdominal 
enlargement is great, it is difficult indeed to fix it in any 
particular position. When distension is extreme, rolling 
is not freely indulged in, and the animal lies down only 
with great care. Other manifestations show the pain to 
be extreme. The breathing is tremendously accelerated, 
coming and going in short, fitful gusts, broken every 
now and again by a short-drawn sigh. The nostrils are 
dilated, the pulse small, weak, and greatly quickened, 
and the visible mucous membranes highly injected. 
The temperature is commonly raised about 2° F. The 
ears and extremities grow deathly cold. Patchy per- 
spirations cover the neck, the shoulders, and the flanks, 
and the whole condition indicates a case of the utmost 
gravity. It is plain to even the most ignorant that 
unless the animal be given speedy relief he will soon 
succumb. Even now the accumulated gases are pressing 
heavily on the diaphragm, and seriously impeding the 
acts of respiration. The consequent deoxygenated and 
gas-poisoned state of the blood renders the bodily tone 
bad indeed, and points to no sign of spontaneous recovery 
on the part of the animal economy itself. 

Diagnosis.—This is simple. The abdominal enlarge- 
ment and the evidence it yields on percussion sufficiently 
point out the nature and seat of the trouble. It must be 
remembered, however, that tympany, when restricted 
solely to the stomach, will also give rise to apparent 
intestinal distension—the abdomen in both cases is 
swollen. Nevertheless, its true nature is quickly ascer- 


192 THE COMMON COLICS OF THE HORSE 


tained. When the flatulence is confined to the intes- 
tine, there will, of course, be an entire absence of such 
symptoms as I have put down as diagnostic of gastric 
tympany. The regurgitations of the cesophagus, the 
attempts at vomition, the trickling ingesta from the 
nostrils, and the gurgling noises in the region of the 
trachea, are all wanting. Should there be doubt, which I 
do not for a moment think possible, a rectal examination 
will soon dispel it. 

Prognosis.— Unless it be a concomitant of some more 
serious condition, a favourable verdict may usually be 
indulged in—that is, if the case is seen early. Itis well, 
however, to hold back one’s prognosis of these cases 
until the operation of puncturing the bowel has been 
performed and its results noticed. The extreme pain, 
the suffocating pressure of the distended intestines upon 
the diaphragm, and the semi-intoxication induced by the 
absorption of the gases, all tend to mask the significance 
of the pulse and othersymptoms. Once the greater part 
of this is relieved by the trocar, the veterinary attendant 
is in a far better position to give a correct forecast. If, 
after this operation is performed, the pulse still con- 
tinues a running-down character, and the symptoms 
of pain do not abate, the case is to be regarded as 
serious, 

Treatment.—Taking the remedial measures in the 
order of their importance, I think prior place should be 
given to surgical interference. Considering its value and 
comparative simplicity, it is surprising that the operation 
of puncturing the bowel—technically known as ‘ entero- 
centesis’—should have fallen into the desuetude it did. 
From almost the earliest times of which we have any 
record it has been recommended by first one writer and 
then the other. Vegetius, in the fourth century, advises 


PVPTESTINAL TYMPANY 133 


its adoption, giving minute instructions as to the seat of 
the operation—in this case, the linea alba, four fingers’ 
breadth behind the navel—and suggesting the instru- 
ments to be employed. Again, I find mention of it in an 
old volume I have before me as I write, written by one 
Leonard Mascall, in the time of good Queen Bess, and 
published in 1600. These are the words: 

‘For a horse that is swolne with much wind in his 
body. Some horse with eating certaine windy meate or 
such herbs, will be so swolne there with as though his 
belly wold burst, and then he will eat no meat, but stand 
and hang downe his head, ready to fall, and so die, if he 
have not speedie help. When ye shall see any horse so, 
the next remedy as I can learne, is: ye shall take a sharp- 
pointed knife, or bodkin, and arme it so with some stay, 
that it go not too deep, for piercing his guts. Then 
strike him therewith through the skin into the body, 
before the hollow place of his haunch bone, halfe a foote 
beneath the backe bone, and the winde will come out 
thereat. Then if ye put a hollow quill therein (or some 
feather to keep it open awhile), the winde will voyd the 
better and so heale againe . . . this hath bene prooved 
the best remedie to save your horse or ox.’ 

In 1656 mention is made of it by Markham, and in 
1776 we find it practised for the relief of intestinal tympany 
by Roem of Dresden. The years 1781 and 1834 reveal 
the operation as still in existence. 

Coming to more modern times, we find it revived in 
this country by Stewart of Glasgow, in 1836, and meet 
with reports of successful cases in 1877 and 1879 by T. 
H. Merrick of Northampton; Alexander Harthill, Louis- 
ville, Kentucky; and the late Captain Russellof Grantham. 
As a matter of fact, I think I may say with safety that 
it is only quite within recent years that enterocentesis 

I3 


194 THE COMMON COLICS OF THE HORSE 


has received the amount of attention it merited, and been 
admitted into the ranks of useful, every-day operations. 
Even now I am afraid that there are not a few who look 
upon this simple means of affording relief with a certain 
amount of awe. . 

Personally, I have been in the habit of using the trocar 
and cannula in these cases for several years. As a result, 
one untoward case has fallen to my lot. The animal | 
afterwards developed unmistakable symptoms of peri- 
tonitis. Fortunately he recovered. In one way the 
case was a lesson to me. I had, in consequence of con- 
stantly employing it, grown to hold the operation in a 
certain amount of contempt, and must confess to having 
grown somewhat careless as to the matter of cleanliness. 
That case pointed out to me the absolute necessity for 
a scrupulous care of the trocar and cannula. It is not 
sufficient to have it apparently clean—it must be anti- 
septically spotless. 

No matter what care is taken of the instrument, a 
rather more common sequel to this operation than the 
above occurs in the appearance of a small abscess at the 
seat of puncture. Probably even the occasional appear- 
ance of this small trouble would also be done away with 
if the spot to be punctured were first rendered aseptic, 
in like manner to the instrument, a procedure that the 
exigencies of the case do not always allow of. 

With regard to the seat of operation, there isa general 
consensus of opinion favouring the right flank, at a point 
equidistant from the last rib, the anterior angle of the 
ilium, and the transverse processes of the lumbar 
vertebrae. Asa matter of fact, any position in the right 
or left flank that offers resonance on percussion may be 
tapped with benefit. Preference, however, should always 
be given to the right, as the mere fact of the colon and 


INTESTINAL TYMPANY 195 


czecum being fixed there renders that position always the 
most likely to give certain results. 

Failing to obtain flatus on the right side, the left should 
next be tried. Unrewarded by a rush of air from one 
spot, it sometimes happens that a second puncture in 
the same region, only 1 or 2 inches removed from the 
seat of the first, is followed by a ready and voluminous 
outrush. That being so, when once the surgeon has 
diagnosed tympany, he should not desist from his attempt 
to give the gases outlet until he has punctured both the 
right and left flanks—if necessary, in more places than 
one. 

The trocar should be at least 6 to 8 inches in length, 
and the cannula vary from } to ;%, inch in diameter. 

Considerable difference of opinion exists as to the 
portion of intestine punctured. I do not think there is 
much room for doubt. In the vast majority of cases it 
is certainly some portion of the large colon. 

As illustrating the relief afforded by puncturing the 
bowel, I give a digest of a case reported by Mr. T. H. 
Merrick, of Northampton :1 


‘On July 10, about noon, I was summoned to a cart 
mare. The messenger informed me that she was in 
great pain, and very much “blown.” I found her to be 
suffering from an acute attack of tympanites, the 
abdomen being greatly distended. The mare was first 
observed to be unwell in the morning about four o’clock, 
when the horsekeeper went to fetch her from the field. 
She was in so much pain that it was with difficulty that 
he got her home. On my arrival the mare’s pulse was 
very weak and indistinct, and numbered 80 per 
minute; the mucous membranes were much injected ; 
the surface of the body and extremities cold; quickened 
respiration, and great uneasiness, I administered the 


1 Veterinary Journal, vol. v., p. 316. 
I13-——2 


196 THE COMMON COLICS OF THE fea 


usual remedies, but failed to give her relief; indeed, she 
got rapidly worse, and became so distressed and helpless 
that I was afraid she would fall. I therefore determined 
on puncturing the intestine. The accumulated gas 
rapidly escaped, and the abdomen quickly subsided. 
The relief afforded in a few minutes was most satis- 
factory. All symptoms of pain immediately ceased. In 
the course of two hours the pulse became distinct, and 
the mare commenced to feed.’ 


The usual course in the development of the abscess 
following this operation is well described by the late 
Captain Russell, of Grantham.! He says: 


‘On November 20 my attention was directed to 
the post horse at the George Hotel, upon which I 
had operated for tympany on October 26, as he had 
lately appeared stiff in his movements and out of 
sorts. On my seeing him and removing his.clothing, I 
perceived a large swelling upon his flank, about where 
the first puncture of the trocar had been made. On 
examining this swelling, I fancied I could feel deep- 
seated fluctuation, and feeling sure I had an abscess to 
deal with, I ordered it to be well fomented for a day or 
two to endeavour to get it to point externally. On 
the 23rd, however, finding it made no progress externally, 
I examined it with an exploring needle, when at a depth 
of 2 inches I came upon pus. Having made a good 
opening, about a quart of creamy pus escaped. The 
case has gone on well, and the animal was discharged 
to-day, December 6, convalescent.’ 


Having removed the gases present in the bowel, we 
have two other matters to consider: Firstly, the preven- 
tion of the further evolution of gases; secondly, the 
removal of the cause. 

The first of these is to be brought about by introducing 
into the bowel some form of antiseptic, or rather anti- 


4 Veterinary Journal, vol. viii., p. 4. 


PNP ESTINAL TYMPANY 197 


zymotic, in order to prevent further fermentation. If 
the colon followed immediately upon the stomach, the 
treatment already recommended for gastric tympany 
would do equally well here. It must be remembered, 
however, that all remedies administered per ovem will 
first have to pass through the small intestines before they 
can reach the seat of mischief, and that the presence of 
large quantities of food in the stomach and fore part of 
the intestines will proportionately nullify their action. 
It follows from this that administration of the antt- 
zymotics by the mouth is not the readiest route, and 
that their direct injection into that part of the intestine 
visibly affected would be far more likely to be followed 
by good results. 

This is the method of operating: The bowel is first 
punctured, in the region of the flank, with an ordinary 
trocar and cannula. After the escape of the gases, the 
antizymotic determined on is injected, by means of 
Toope’s injection cannula, directly into the intestine.! 
This generally proves effectual in staying the re-forming 
of gas, and the further treatment of the case will run on 
ordinary lines, 

Useful antizymotics for this purpose are carbolic acid, 
Jeyes’ fluid, boracic acid, hyposulphite of soda, turpen- 
tine, lysol, etc. 

Probably the most simple and effective of these is 
carbolic acid, and it may safely be injected in 1 to 6 
or 8 drachm doses, when freely diluted with water. 
Four drachms to the pint will be found a serviceable 
solution. When used in stronger solutions, or injected 
cold, it is likely to set up a somewhat alarming attack of 

1 This may also be quite easily done with an ordinary smail 


trocar and cannula, using a Higginson’s syringe, with milking 
syphon attached, to inject the fluid, 


198 THE COMMON COLICS OF THE HORSE 


shivering. Even this, however, appears to quickly pass 
off, and leaves no after ill-effects. In addition to its 
property of staying fermentation, the carbolic acid acts 
somewhat as a local anesthetic, and, without exerting a 
general sedative action, serves to allay pain in that 
portion of bowel with which it comes in contact. 

Professor O. C. Bradley, while in charge of the New 
Veterinary College Infirmary, reports three cases in 
which this treatment was adopted. Two of these I give 
below : 


1. ‘2 f£m.— Bay cart gelding admitted. Colicky 
symptoms, much tympany. Punctured, and injected 
4 a of carbolic acid in 1 pint of water. 

‘3 p.m.—Much better. No recurrence of tympany, 
pulse 65. 

‘4 p.m.—Still improving, colicky symptoms have dis- 
appeared, pulse and respiration normal; continued 
seg 

‘6 am.—Black cart mare admitted. Great pain, 
Ge tympanitic; pulse weak, respiration much ac- 
celerated. Punctured, and injected 2 drachms of carbolic 
acid in solution. Morphine hypodermically. 

‘6.30 a.m.—Easier. Pulse 70. 

‘8 a.m.—Again tympanitic and very restless. Punctured 
again, and injected 3 drachms of carbolic acid in 1 pint 
of water. 

‘g a.m.—-Better. Pulse 60 and stronger, respirations 
slower. Has stopped walking about.’ 


The removal of the cause is clearly to be brought 
about by the administration of a purgative. The fer- 
mentation has evidently been occasioned by the ingestion 
of unsuitable, mouldy, or imperfectly masticated food. 
The sooner this gains exit from the body the better for 
our patient. Personally, I am not always disposed to 
wait for the action of an ordinary cathartic. Having dis- 
posed of the gases already present, and ascertained that 


INTESTINAL -TYMPANY 199 


the patient’s condition will allow of it, I prefer to inject 
hypodermically 13 to 2 grains of eserine sulphate. The 
bowels soon respond, the offending materials are quickly 
voided, and the patient, after the lapse of an hour, is left 
free from the probability of another attack. 

Frequently this is all that is necessary, and the need 
for intra-intestinal injections of carbolic acid is thus done 
away with. Should the eserine fail to act, and the gases 
commence to reaccumulate, there is then time for the 
carbolic acid injection to~be administered. 

From what I have written, I do not wish the reader 
to infer that I absolutely discountenance the administra- 
tion of remedies by the mouth in this form of colic. 
Sooner, I consider it better to ‘have two strings to one’s 
bow,’ and, even whilst adopting the lines I have recom- 
mended, to still continue administering the usual 
stimulants and antispasmodics in the form of balls or 
drenches. 

Again, however, this time in company with others, I 
place the most severe strictures upon the use of sedatives. 
The cause of the tympany is the presence of fermenting 
materials in the intestine. There is no just reason for 
iocking them there by the injudicious use of anodynes. 
The reverse is the case, and every medicine administered, 
save such as is purely antizymotic in its action, should 
be, in some form or cther, essentially stimulative. The 
use of enemas is again indicated, and the patient should 
be well rugged down in order to promote warmth. 
Treated on the above lines, ordinary cases of intestinal 
tympany will quickly respond, and offer no great amount 
of anxiety. 


CHAPTER XVI 


ENTERITIS: INFLAMMATION OF THE 
BOWELS 


Definition.—Colic resulting from a morbid condition of 
the intestinal coats, manifested by extreme and con- 
tinuous pain, and characterized by its rapid course and 
great fatality. 

Regarded in the light of a simple inflammation, the 
term ‘enteritis’ is evidently a misnomer, so far as our 
knowledge of equine cases leads us. The post-mortem 
examination of the intestines tends more to point to the 
fact of its being a general bacterial infection of the blood- 
stream, commencing from the intestines. 

What draws us to this conclusion? I can better lead 
up to it by quoting at length from a paper by Mr. Cun- 
ningham, of Slateford :1 

‘What is this inflammation,’ he asks-——-‘ this hemor- 
rhagic inflammation of the bowels? A favourite cob has 
been working hard, he is laid off lame, and your man is 
very kind to him, and at night you are suddenly sum- 
moned to find the cob that has carried you so long, 
and which you know has never had a touch of colic in 
his life, posting on in two short hours to its end. A 
farmier buys a horse, young and cheap, in poor condition ; 


1 The Veterinarian, vol, lix., p. 45. 


ENTERITIS 201 


he is good to it; it does well and thrives, He is proud 
of his bargain, and suddenly on the road it takes ill, and 
in a couple of hours you tell him to prepare for the worst, 
for though his horse will live to the morning, it will cer- 
tainly die. A horse passes your place with his load at 
nine o’clock in the morning, goes three miles, is seized, 
returns, and by twelve o’clock lies a carcass in your box, 
after a few hours’ ceaseless agony. This is worse than 
cholera, What is this disease? You examine the 
carcass, and find the veins, superficial and deep, filled 
with black, fluid, tarry-looking blood; the abdomen 
quarter full of thin, watery, dark-purple, or rusty- 
coloured serum; the stomach and bowels with consider- 
able contents, but not more than many a healthy horse 
in full feeding. The mucous membrane of stomach 
congested, and its villous portion inflamed and eroded ; 
the secretions sour and acid, and their contents acrid and 
high-coloured, Rectum not much amiss, but the cecum 
and colon tell another tale. Purple-looking, black, and 
dirty-coloured inside, thickened and swollen to 4 inch 
or I inch in thickness, with contents partly solid and 
partly fluid and purple-coloured, we find in them the true 
seat of this hemorrhagic inflammation. 

‘Take a piece of healthy large intestine, examine it 
carefully, and you find it is about $ inch thick, the 
muscular and peritoneal coats are firmly attached and 
adherent to each other, while the internal mucous is 
loosely attached by cellular tissue to the muscular, with 
a considerable amount of fat interposed, forming a sort 
of cushion or bed, in which the lacteals and blood- 
vessels may lie and ramify. All the three coats are pale 
and destitute of high colouring. 

‘Take an inflamed piece of large intestine, dissect it 
carefully. You find + or 4 inch, or even 1 inch in 


ote THE COMMON COLICS OF THE HORSE 


thickness, firm and dense, and almost hard to the feel. 
The peritoneal and muscular coats still adhere closely, 
but they are thickened and swollen, and soaked with 
effusion. Still, they do not appear to be acutely or 
actively inflamed. The mucous coat is black or dark- 
purple coloured, the seat of the most intense and 
evidently acute (or it may be passive) inflammation, but 
still not much thickened ; its inner lining is black and 
dirty-coloured, studded with minute openings, while the 
space between the mucous and muscular layers is filled 
and gorged and swelled with effusion, the chief cause by 
far of the increased thickness of the bowel, and the 
effusion is clear, not dark-coloured at all; while in the 
peritoneal folds, connecting the divisions of the gut, 
lymph, watery but clear and amber-coloured, as from a 
_pleuro-pneumonia lung, may be found in abundance. 

‘If this is simple acute inflammation, where in the 
animal economy have we another example of such rapid, 
fatal, and extraordinary results in the space of a few 
hours from simple, pure, acute inflammation, and 
nothing else ? 

‘Is it due simply and solely to the presence and 
mechanical irritation produced by large quantities of 
indigested material in the organs? ‘Then, surely, a 
horse with a 13-pound dust-ball, or one packed with 
fodder beside, should be its readiest victim. But we 
know that such is not the case. Is embolism the cause? 
I believe, in one or two instances, one might be justified 
in saying so. Isit anthrax? I do not think the lesions 
justify that conclusion. Is twist or displacement the key 
to the mystery? I believe in some this does supply the 
key, and that some of the so-called cases of inflamed 
bowels are simply cases of twist or displacement; but, 
on the other hand, of the many cases I have examined 


ENTERITIS 203 


after death, in only a few, comparatively, have I been able 
to trace any distinct twist, intussusception, or strangula- 
tion.’ 

Causes.—Seeing that nothing is clear, we can only 
reason by analogy. We know that in at least one other 
disease such appearances as are revealed in a post- 
mortem of a case of enteritis are certainly caused by a 
bacterial invasion of the intestinal bloodvessels. We 
also know that the symptoms closely correspond, that 
the pain is just as agonizing, and that the illness is just 
as fatally rapid. I am referring to anthrax. 

When, after the experience of such a case, one meets 
with another in which the onset is similar, the symptoms 
almost identical, the issue just as much a foregone con- 
clusion, and the post-mortem appearances hardly 
distinguishable, one may be excused for referring it to 
a similar cause. In the first case the cause has been 
carefully and indisputably shown to be anthrax.! In the 
second, the most painstaking search fails to reveal its 
presence. We know that the second caseis not anthrax, 
for the methods that revealed it once should expose it a 
second time, and are therefore able to assume that its 
cause must be a rapid invasion of the lacteals and blood- 
stream by some germ or other as yet undemonstrated. 

Allowing this to be the fact, it does not, for a moment, 
detract much from what other writers have put down as 
the usual causes. Take, for instance, such commonly 
quoted causes as over-fatigue, cold from exposure, and 
washing the belly with very cold water when the animal 

1 T am able to vouch for the truth of that statement from the 
experience of a case that occurred in my own practice. The animal 
died, showing every symptom of so-called enteritis. The case was 
diagnosed as such and treated as such. As a result of the post- 


mortem, I was able to definitely deinonstrate the presence of the 
Bacillus anthracis in the blood.—H. C. R. 


204 THE COMMON COLICS OF THE HORSE 


is heated. It is conceivable that either of these factors 
would tend to lower the body vitality, and that any pre- 
disposition there may have been would be hurried into 
an attack by their aid, such predisposition being the 
presence of the necessary virus in the intestinal tract, 
and some condition of the bowel wall (irritation from 
calculi, impaction, etc.) favouring the entrance of the 
germ. 

At any rate, whatever may be the real explanation, it 
is simply madness for anyone to imagine that any such 
trivial cause as cold, over-fatigue, etc., is sufficient fer se 
to bring on an attack. As Williams rightly enough puts 
it, ‘It is very true that impaction, constipation, intussus- 
ception, volvulus, the presence of calculi, or the action of 
irritant poisons, may cause great congestion and inflam- 
mation of the intestinal membranes; but the disease to 
be described originates sw generis, and very often without 
the occurrence of an immediate and recognisable cause 
of direct irritation.’ 

Although in practice we are somewhat inclined to 
hold out to our clients the possibility of a case of ‘colic’ 
terminating in enteritis, I should imagine that it is simply 
a case of ‘ digging a large enough hole toclamber out of’ 
should the animal unfortunately die. Ido not think that 
any one of us honestly believes it likely to happen in any 
great number of cases. We are far more likely to 
inwardly admit that the case we have misdiagnosed as 
‘simple colic’ is, in reality, one of twist, intussuscep- 
tion, etc. 

That being so, and taking Williams’ statement, ‘that 
the disease originates sw generis,’ to mean that there is 
some specific cause, then there is no other solution that 
fairly satisfies the problem save the one I have suggested 
—that of bacterial infection. 


ENTERITIS 205 


Symptoms.— Unfortunately, these are too well known 
to need any lengthy description. The history of the case 
invariably points to the attack having been ushered in 
with rigors. In the language of the stable, ‘the animal 
is taken with a shivering fit.’ The appetite fails, the 
breathing becomes quickened, and the bowels show signs 
of commencing irritability by frequently ridding them- 
selves of small quantities of feces. 

Following this, the symptoms of abdominal pain com- 
mence, and, gradually increasing in intensity, remain 
until near the end of the case. All indications of the 
most severe suffering are present. ‘The animal strikes 
at the belly with his feet, casts anxious and dolorous 
looks towards the flanks, and commences alternately 
rolling and rising to his feet, and sometimes biting madly 
at his sides. The pulse is increased in number, hard, 
wiry, and quick, up to 120 beats a minute, and often 
scarcely to be felt, except at the radial. The belly is 
usually normal in size—no tympanites—and appears 
more or less tucked up, owing to the contraction of the 
abdominal muscles, while pressure on it, in some cases, 
appears to cause pain. Profuse perspirations bathe the 
body, and the ears and legs grow deadly cold. 

All the time the pain has been continuous. No 
moment’s remission from suffering has eased the agonized 
patient and relieved the veterinarian’s mind. No second 
of quiet has occurred to break the dread hurrying forward 
of the fatal symptoms. The animal gradually grows 
worse and worse, and every symptom here mentioned 
appears to become aggravated. The countenance 
becomes pinched and haggard in the extreme; the 
sweats become slowly colder, suggesting to the touch 
the nearness of dissolution, and causing the hand to 
be withdrawn with a shudder; the visible mucous 


206 THE COMMON COLICS OF THE HORSE 


membranes are an intense livid red; the nostrils are: 
widely dilated, and the breath coming and going in short, 
painful sobs. The getting up and down has resolved 
itself into a ceaseless circular tramp around the box; 
the pulse has become more imperceptible still, but yet 
maintains its speedy beating, and the belly is growing 
tympanitic. 

Later still, all symptoms of pain quickly subside. 
The bowels, so lately the seat of the most agonizing 
spasms, have become gangrenous, and consequently dead 
to feelings of pain. The animal then stands quiet, and 
will even drink and endeavour to feed. The owner is 
pleased, and anticipates recovery. Not so the veteri- 
narian. He knows too well that it is but the beginning 
of the end. | 

The haggard expression of the face still remains; the 
pulse continues thready and imperceptible; the ex- 
-tremities are even more cold than before; the mouth is 
cold, clammy, and fcetid, and the body is shaking with 
involuntary tremors. The eyes grow amaurotic; the 
lips hang pendulous; the legs are widely propped apart 
to keep the staggering, half-unconscious brute upon his 
feet, and a nervous, anxious whinny greets a passing 
equine friend. 

But a short time further sees the end. The stagger 
gives way to an aimless blunder forward; the limbs 
collapse, and the tortured animal sinks to expire in con- 
vulsions. What was, perchance, but six short hours 
before a handsome specimen of the equine race, with 
beauty, health, and strength depicted in each line of his 
glossy, well-kept body, now lies a dirt-besmeared, worth- 
less carcass. 

Diagnosis.—-Once seen, I do not think that enteritis 
is often likely to be misdiagnosed. As a boy, I] 


ENTERITIS 207 


remember committing to memory a tabular arrangement 
of the differentiating features of enteritis and ordinary 
colic. I found it in one of those old-fashioned works 
that, in one volume, deal with the whole ‘art and practice 
of farriery,’ as necessary for ‘all those who have the 
government of cattle.. Somewhat too precise and over- 
condensed it may appear to modern minds, and yet it is 
not without its merits. This is how it ran: 


Colic. : Inflammation of the Bowels. 
1, Sudden in its attack. x. Gradual in its approach, with 
previous indications of fever. 

2 Intervals of rest. 2. Constant pain. 

3. Pulse only becomes frequent 3. Pulse continuously frequent 
in the paroxysms of. pain. but small, and often scarcely 
In intervals of ease is normal to be felt. 
in number of beats, but evi- 
denily fuller. 

4. Legs and ears of the natural 4. Legs and ears cold. 
temperature. 

5. Relief obtained fromrubbing 5. Belly exceedingly tender and 
the belly. painful to the touch. 

6. Relief obtained from motion. 6. Motion increasing pain. 

7. Strength scarcely affected. 7. Rapid and great prostration. 


Really that table offers the major points to be con- 
sidered when forming an opinion. To it I would add 
that the circumstance of the conjunctiva being so highly 
injected, and the fact of the pulse, temperature, and 
respirations all three immediately participating in the un- 
favourable indications, are all manifestations of a highly 
dangerous condition. 

Almost all writers appear to agree in stating that the 
belly is tender to the touch. Allowing that it is, it is 
always difficult to judge, for one never knows how much 
of the flinching and resentment should be put down to 
restiveness, 


208 THE COMMON COLICS OF THE HORSE 


After all is said, Percivall’s summing up remains as 
good now as on the day on which it was written: ‘The 
surest diagnosis between colic and enteritis,’ he says, ‘is 
to be found in the history of the case—in particular, in 
the manner of the attack, in the intermissions, in the state 
of the pulse, and in the progress of the case.’ 

Prognosis.—Once certainly diagnosed, enteritis offers 
but little hope of recovery. It is so commonly fatal as 
to warrant an unfavourable opinion being expressed in 
every case. 

In ordinary cases of colic, as, for example, impaction, 
irritation by calculi, diarrhoea, etc., there is no doubt that 
we often get a condition that properly comes under the 
term we are now in all probability misusing. ... We 
get a limited enteritis. ... The occasional slight rise 
of temperature in these cases is sufficient to point that 
out. Such of these cases as yield to remedial measures 
may be rightly classed as recoveries from enteritis. The 
name ‘enteritis,’ as signifying the disease I have been 
describing, has become such a well-known part and 
parcel of veterinary nomenclature that I have not. dared 
to head this chapter by any other term. Had not such 
been the case, I should have suggested for this disorder 
some such appellation as ‘intestinal septic infection,’ 
‘intestinal septicemia’—-in short, any other suitable 
name that would have left the word ‘enteritis’ to be 
properly applied to those conditions it more fitly 
describes. That the disorder we have described 7s an 
enteritis, or inflammatory condition of the bowels, I 
do not attempt to deny. I simply maintain that its 
manifestations are so peculiar to itself as to point to 
a specific cause—that it is a disease by itself—and 
ought, therefore, to be given such a name as would 
definitely distinguish it from those comparatively minor 


ENTERITIS 209 


complaints covered by such an all-embracing term as 
‘enteritis.’ 

The statement with which I have headed this section 
would then need qualification. Recovery from the 
limited enteritis attending other and less dangerous forms 
of colic is not only possible, but a matter of every-day 
occurrence. 

On the other hand, resolution in a case of ‘ intestinal 
septicemia,’ if I may, for a moment, be allowed to so 
call enteritis, will occur with about the same frequency 
as recoveries from the intestinal forms of anthrax. 
Knowing that, the practitioner will appreciate my 
statement, ‘enteritis offers but little hope of recovery,’ 
at its true value. | 

Treatment.—I must confess myself to looking upon 
this as hopeless. Once established, I do not think that 
enteritis—at any rate the enteritis I have described—is 
in the slightest degree affected by anything we may pour 
into the animal’s body. Though not affecting the issue 
of the case, humanity points to a manifest duty. It 
should be our care to render, if possible, any aid that will 
mitigate the animal’s sufferings. To that end, the most 
potent anodynes and sedatives should be employed. 
Even should we succeed in inducing a state of delirious 
drunkenness, that is manifestly better than allowing the 
patient to succumb in agonizing tortures. 

Should the practitioner deem this advice too dogmatic, 
and conscientiously feel that other remedial measures 
should be attempted, he will find plenty to his hand in 
other and well-known volumes. Personally, I do not 
think that our knowledge of the etiology of this disorder 
justifies us in thrusting upon the already tortured animal 
drugs the action of which, in this particular instance, 
must be highly problematical. This is one case in which 


14 


210 THE COMMON COLICS OF THE HORSE 


we may safely take the advice of a cynic, whose name | 
do not remember, and ‘refrain from pouring medicines 
of which we know little into a body of which we know 
less.’ 

Rather should the attention of those among us who 
have a natural liking for investigation be strenuously 
devoted to searching for a well-defined and certain cause. 
We may then be better directed towards devising a suit- 
able treatment. All this indicates most strongly that 
the practitioner of veterinary medicine should be quite 
certain of his diagnosis before he commences the merciful 
administration of anodynes. 

In spite of the most careful reasoning, and in spite of 
the most painstaking examination and observation, cases 
of colic occasionally crop up in which the symptoms are, 
for a time, dangerously alarming. Enteritis immediately 
suggests itself to the practitioner’s mind, and he com- 
mences the exhibition of sedatives. Before he does that, 
I would earnestly advise him to wait until his somewhat 
tentative opinion has become an absolute conviction. If he 
has not the courage to commence a stimulative treatment 
at the outset, at any rate let him adopt harmless 
expectant measures. Should the case turn out to be 
enteritis, he may confidently assure himself that anything 
he might have done would have been useless. 

On the other hand, should the alarming symptoms 
begin to abate, and the matter resolve itself into some 
more simple form of colic, he will then have the 
advantage of being able to push stimulative measures on 
a system that has not been previously placed outside the 
pale of hope by the undue administration of sedatives. 
He will find the average of his cases of so-called enteritis 
considerably diminish in the course of a twelvemonth’s 
reckoning, and, greater boon still, he will find his powers 


ENTERITIS 211 


of diagnosis in colic enormously on the increase. That, 
at any rate, has been my own experience. 

To my mind, it is largely this dread of enteritis, and 
the idea the practitioner has that he may be able to ward 
it off by the use of sedatives, that has tended to paralyze 
any forward movement towards the better differentiation 
and diagnosis of cases of veterinary colic. 


14—=2 


CHAPTER. XVII 
SUPERPURGATION 


Definition.—That form of colic induced ty the in- 
ordinate action of a purgative. 

Referring to Chapter I., and consulting Professor 
Friedberger’s table, we find that this particular form of 
colic would come under the heading ‘ symptomatic,’ and 
that further classification would lead us to the fact that 
it is colic resulting from the administration of a 
poison. ... We must either dub aloes ‘a poison,’ or 
inform Professor Friedberger that his table is incomplete, 
and that he has made no mention of a form of colic 
resulting from the administration of a harmless drug. 
For my own part, so far as the horse is concerned, I 
regard aloes asa poison. ‘The astounding fact to me is 
that it has not been so called before. 

Williams, in his ‘ Principles and Practice of Veterinary 
Medicine,’ devotes a chapter to the consideration of this 
condition, admitting that it is of frequent occurrence, and 
yet not advising the more restrained use of aloes. 

Surely it is an astonishing thing that a drug which will 
commonly give rise to such dangerous symptoms as to 
call for a separate chapter concerning its antidotes 
should not be regarded as highly dangerous. Why is it 
that other drugs have not elevated other conditions to a 


SUPERPURGATION 213 


position of the same fatal prominence? Why is it that 
aloes, above all other drugs, should be singled out in this 
manner? Simply because it is dangerous! 

If a new drug were introduced to-morrow, with only 
one-half of the possibilities of danger already inherent in 
aloes, its use would be indignantly scouted by more than 
two-thirds of the veterinary profession. And yet, I 
venture to say, there are but a very few who would dare 
to assail aloes in the same manner. 

Regarding the medico-legal questions involved in its 
use, Williams says: 

‘The occurrence of superpurgation after the ad- 
ministration of a simple and moderate carthartic by the 
veterinarian is one of great importance. In no case 
where due caution has been taken, where the dose 
has not been more than the necessities of the case 
required, . . . should the veterinarian be made re- 
sponsible.’ 

Personally, I should consider a man deserving of any 
trouble that might accrue therefrom who systematically 
uses aloes in his practice without urgent calls for its 
administration. Physicing after grass, to get into con- 
dition, to remove a tendency to swelled legs, . . . all 
these I look upon as foolish and useless fads—practices 
which the intelligent veterinarian will endeavour to 
root out from those of his clients who are amenable to 
reason. 

Causes.—Although giving aloes the foremost position 
among the causative factors of this dangerous condition, 
it must not be forgotten that other and more simple 
purgatives will bring about a like result if improperly 
administered, or if due care is not afterwards taken of 
the patient. 

In a case of pneumonia, for instance, 4 pint of some 


214 THE COMMON COLICS OF THE HORSE 


simple bland oil—e.g., that of linseed—will be quite 
sufficient to cause it. Or, again, if the animal is put to 
work during the operation of even a simple cathartic, or 
is exercised too soon after its ‘ setting,’ the same dire 
results are likely to follow. 

This only shows the extreme susceptibility of the horse 
to the action of purgatives, and, if anything, serves to 
still further discountenance the common use of such a 
drastic purge as aloes. 

Symptoms.—Should the purgative act in an easy 
manner, but little disturbance of the system will be 
noticed. The pulse becomes a little weaker, less full, 
and its frequency increased. When the purging is about 
to commence the coat will be staring, and occasional 
tremors present themselves. The animal at this stage 
is nauseated, appears restless, refuses his food, and shows 
a slight increase in the number of respirations, | 

Following this comes the increased action of the 
bowels and the evacuation of their contents. If every- 
thing goes well, a few hours will see a gradual return to 
the normal. The breathing becomes more tranquil, the 
pulse grows fuller and more quiet, and the appetite 
again returns. 

Should the dose have been unsuited to the patient, 
however, or should some adverse circumstance have 
been in operation, the symptoms rapidly grow more 
alarming. For example, if there has been any previous 
slight symptom of fever, if the animal is allowed to drink 
large quantities of cold water, or if he be exercised or 
over-excited in any way, an excessive action of the drug 
may assuredly be expected. 

It is not always, however, that a large dose of aloes is 
needed to bring this about. It is not always that any 
other adverse circumstance need be in simultaneous 


SUPERPURGATION 215 


operation to bring about a fatal result. It is in these 
last two facts that the danger of using aloes exists. 
Every veterinary surgeon, I might say without excep- 
tion, is aware of them, and he still persists in an indis- 
criminate use of the drug. 

Williams himself says: ‘Superpurgation does net 
always depend upon the strength of the dose. In some 
instances as little as 4 drachms have been followed by 
fatal consequences. Again, horses in an obese con- 
dition ... are easily acted upon by purgative medicines, 
and are apt to sink from superpurgation.’ 

Be that as it may, whether a large dose is necessary 
or not, or whether any predisposing circumstance at all 
is needed, it still remains that often the purge does not 
cease, but gives rise to the following and more aggravated 
symptoms: 

The appetite fails to return; the discharge becomes 
more fluid, more frequent, and extremely offensive, and 
the mucous membranes become injected. The mouth 
is dry, furred, and foetid, and the respirations hurried. 
After each evacuation the animal shows evident colic 
pains, manifesting them by crouching movements, and 
occasionally lying down. Usually, however, he stands 
quiet, and only exhibits his pain by wandering round the 
box or pawing with one foot on the ground. The pulse 
has become thready, weak, and quick, and prostration 
becomes alarmingly evident. ‘The extremities turn cold, 
and the belly appears abnormally tucked up—in some 
cases tympanitic. Everything points to a speedy 
collapse. The practitioner is only too painfully aware of 
the danger of his case, and understands full well that the 
most prompt and energetic measures are necessary to 
combat the condition. | 

Diagnosis.—The history of the case and the evidence 


216 THE COMMON COLICS OF THE FG 


of one’s own senses leads one quickly enough to the 
truth. More than that need not be said. 

Prognosis.—To a great extent this must always be 
guarded. Even should the pulse and other symptoms 
point to nothing really alarming, the practitioner must 
always bear in mind the only too probable sequels of this 
condition. 

Many cases, unfortunately, end with some such serious 
trouble as pneumonia; others in a long and severe 
attack of laminitis, leaving the animal a useless cripple. 

Taking these as only of occasional occurrence, no one 
will attempt to deny the susceptibility of the horse to 
enteritis, That alone should lead us to endeavour to 
explain to the owner the risk the animal is running, and 
prepare his mind for the probability of the patient rapidly 
sinking under an exhaustive inflammation of the bowels. 

Treatment.—Called in at the commencement of 
doubtful symptoms, the best and most simple treatment 
is a dose of chloral. 

R. Chloral hydratis - . . - - Bi. 
Aq.fervens - - . - a ie - ad 3x. 
Misce; fiat haust. 
Sig.: To be given in a pint of thick, cold gruel. 

It is unusual, however, for the veterinary surgeon to 
be summoned early. MHe is not called in until the 
symptoms have become really dangerous. He finds his 
patient with quick and feeble pulse, abdomen drawn up, 
and extremities cold. 

Again I advise the administration of the chloral, this 
time accompanied with a hypodermic injection of from 
3 to 5 grains of acetate of morphia. This will tend to 
allay the irritability in the intestines, and induce a com- 
fortable sleep. At the same time the animal should be. 
well rugged down and kept perfectly quiet, 


SUFERPURGATION 217 


If the flagging system appears to demand it, a stiff 
dose of some diffusible stimulant will be found beneficial. 
Ten to fifteen ounces of good brandy, or a suitable dose 
of spirits of nitrous ether, methylated ether, or the 
aromatic spirits of ammonia, will do all that is needed. 

The combined effects of the purging and the taking of 
the sedatives will sooner or later cause an intense desire 
for drink. Advantage should be taken of the animal’s 
thirst to induce him to swallow small quantities of 
wheaten-flour gruel or other emollient drink. This | 
have always found better to give cold, for oftentimes the 
drinking of only a few mouthfuls of something cool and 
refreshing will tempt the animal to pick a little solid food 
—a few handfuls of hay or a small quantity of corn. 
This will go far to bring the stomach and intestines to 
their normal tone, and stay the purging. 

Some practitioners pin their faith to opium. Unless 
the case is one of great urgency, I do not recommend it. 
Following its administration we are often immediately 
jumped from the extreme of violent purging to the height 
of absolute stasis and tympany. It is hard indeed to say 
which is the worse condition of the two. 

In conclusion, I feel it necessary to remind the reader 
that this chapter has not pretended to treat of acute 
diarrhoea arising from other causes, as, ¢.g., the ingestion 
of irritating or fermenting foods. In those cases the 
extreme sedative treatment I have recommended is not 
to be advised. “‘Theaction of the bowels should not, then, 
be checked too rapidly. Mather, if the patient’s strength 
will admit, should they be aided in ridding themselves of 
the offending materials. 

No fixed rules for the treatment of ordinary purging 
can be laid down with any safety—so much must be 
left to the good sense and judgment of the medical 


218 THE COMMON COLICS OF THE HORSE 


attendant; so much will depend upon the history of 
individual cases, and the patient’s idiosyncrasies. As old 
Francis Clater clearly enough puts it, ‘Nothing so 
much distinguishes the man of good sense from the mere 
blunderer as the treatment of purging.’ There is no 
reliable ‘rule of thumb’ method in medirine. Each 
case must be treated upon its own merits. 


CHAPTER XVIII 


THE TREATMENT OF YOUNG, UN- 
BROKEN ANIMALS 


Wuat I am about to write of now may mote concern 
the student and beginner than the staid man of practice. 
Nevertheless, I did not feel this little volume to be com- 
plete without some mention of the matter now under 
consideration. 

Yearlings and Two-year-olds.—There is nothing so 
difficult, even to the practised veterinarian, as the correct 
diagnosis of ‘colic’ in an unbroken colt. In many 
instances the animal is, perhaps, at pasture. He is seen 
to be lying or rolling about, and is driven up into the 
yard for treatment. If he is fortunate enough to have 
received no pulling about or forcing of medicines upon 
him by the owner, the patient will give a tolerably clear 
account of his trouble to the skilled attendant. More 
often than not, however, he will have been haltered and 
twitched, and some patent ‘cure-all’ thrust upon him. 
In that case the excitement of his new surroundings, and 
the exertion of fighting against restraint, will have led to 
a perplexing set of symptoms. He is, perchance, in a 
bath of sweat, his conjunctiva injected, his respirations 
enormously hurried, and his pulse beating at a frantic 
rate, All this may be due to the treatment he has 


220 THE COMMON COLICS OF THE HORSE 


received, and may not always be taken as evidence of 
pain. Prognosis—nay, even diagnosis—should be 
extremely guarded in such a case. 

If, on the other hand, the animal has been allowéd to 
remain without interference in the place in which he was 
taken ill, the veterinary surgeon will start with a ‘clean 
slate.’ That will give him great facilities he should not 
fail to take advantage of. On no account should the 
animal be immediately haltered and handled, for most 
certainly that will effectually mask what symptoms he 
may be presenting. He should be quietly watched, and 
the few signs he shows carefully estimated. The in- 
formation likely to be derived from this preliminary 
observation I have already detailed in the chapter ‘ How 
to Examine the Patient.’ Even then the veterinary 
surgeon must take into consideration the class of horse, 
and probable temperament, with which he is dealing. In 
a high-bred, nervous animal, the unusual position in 
which he finds himself (that of unknown, and to him un- 
accountable, pain) and his natural timidity make him in 
many instances altogether hide his distress. He may be 
suffering untcld agonies. Yet he stands quiet, and only 
reveals the intensity of his torment by such signs as may 
be noticed by this introductory ‘look round.’ 

Our next patient, with nothing really serious ailing 
him, may roll and smash about to an alarming degree, 
is more subdued when caught and handled, and lends 
himself well to manipulative examination. 

These are the two extremes. There are all gradations 
between the two, and the veterinary surgeon must in 
each instance judge the case from its own standpoint. 
Care should be taken to notice the way in which the 
patient takes a drench. If he is at all restive and in- 
clined to fight against it, it should be withheld, and the 


THE TREATMENT OF YOUNG, UNBROKEN ANIMALS 221 


after-treatment carried on by means of balls, hypodermic 
injections, and suitable enemas. If this precaution is not 
taken, and forcible drenching is persisted in, the veterinary 
surgeon will have a much worse case on his hands in the 
shape of a severe attack of pneumonia, caused by the 
aspirating of the liquid. 

To the beginner, with his first case of ‘ colic’ in an un- 
broken colt, I would advise this: ‘ Put your case down 
half as bad again as your diagnosis has led you to 
imagine, and you will be nearer by far to the truth of the 
animal’s condition.’ 

Foals.—In these days of extensive breeding of high- 
class stock, with the increase in value of their progeny, 
the foal will demand a large share of our attention. 
Those resident in or near a large breeding centre know 
full well the many annoyances and disappointments met 
with in treating these delicate animals. The veterinary 
Surgeon’s position is rendered the more difficult in that 
every foal, when he is dropped, is looked upon with 
loving eyes and watched with careful tenderness, as a 
probable future money-mill in the shape of a successful 
stallion, or the winner of substantial money prizes at 
the agricultural shows. 

There is not one in fifty that fulfils the hopes so 
centred on him by his owner, and, when he becomes a 
raw and ugly yearling, oracomparatively worthless two- 
year-old, the veterinary surgeon may treat him without 
anxiety. Still, as a foal he is an unworked gold-mine. 
He is regarded as such by his owner, and, as a conse- 
quence, his case must be treated with every solicitude by 
the veterinarian. 

Paradoxical though it may appear, the treatment of 
‘colic’ pains in foals is both simple and difficult. It is 
simple in that the best remedies are those usually affected 


222 THE COMMON COLICS OF THE HORSE 


by the owners themselves—the cases partaking more of 
the nature of a baby and its nurse than of the adult patient 
and his medical man. They are difficult in that our powers 
of diagnosis concerning them are as yet but limited. 

Diarvrhea.—Probably the most common form of colic 
in the very young foal is that occasioned by diarrhcea— 
‘scouring,’ as it is commonly termed. If the case has 
not been long about, and the young animal is fairly 
strong, by far and away the best initial treatment is a_ 
suitable dose of castor-oil. This is best given in the 
form of an emulsion. The following is a good mixture 
for the purpose : 


Rh. Ol. ricini e e e s e e od 3i. 


Liq. potassa . ° ° ° ” -  M|xxx. 
Ol. menth. pip. - - . s ° - lv. 
Aquam - - : - . « - ad Jii. 


Misce ; fiat haust. 


If the foal is but a week or so old the above quantity 
will be found sufficient. If at all older and not weakly, 
double the quantity may safely be given. In many 
cases, where the symptoms appear to demand it, a suit- 
able stimulant may be added in the shape of spts, 
ammon. ar., spts. eth. nit., or a small dose of brandy. 
Very often, after the lapse of only a few hours, this dose 
of castor-oil will have stayed the purge. Should it have 
failed, it will then be necessary to follow it up by the 
administration of combined astringents, antacids, and 
sedatives. The following is a very old-fashioned recipe, 
and yet one of the most suitable: 


J}. Catechu pulv. - ° > . 2 age 
Cretz preparate - . = ° : \aa Sul, 
Spt. ammon, ar. - = - - - ii. 
Tinct, opi —- - ._ ss . = a 
Aquam - : - - - . ° - ad 3xii. 


Misce ; fiat mist. 


THE TREATMENT OF YOUNG; UNBROKEN ANIMALS 223 


This may be given in 1 or 2 ounce doses as the case 
demands, mixed with a little of the mare’s milk. 
a ollowing the administration of the sedatives, careful as 
we may be with the dose, it often happens that we have 
to face a case of intestinal stasis. This must be carefully 
treated by means of the castor-oil emulsion, this time 
combined with a small quantity (say, M_xxx. to 31) of 
tinct. nucis vom. Perhaps a rather more suitable line of 
treatment, however, is to combine the castor-oil with 
glycerine, thus: 


BR. Ol, ricini ° s e © e @ oy Zi. 
Glycerini - - . ° . ’ - 5Ss. 
Ol. menth. pip. - : - . ° - mx. 
Aquam - - - - . - ad ii. 


Misce ; fiat haust. 


These cases of scour are often very troublesome, and 
much will depend upon the good judgment and careful 
attention of the nurse—not the veterinarian. ‘The foal 
should not be dosed standing, but thrown on its side. 

When attending a case of colic in a very young foal in 
which there is no definite sign or history of scour, the 
veterinarian must be extremely careful. ‘There are at 
least two conditions which may seriously mislead him 
in his diagnosis—viz., accidental bruising of the intestine and 
scrotal hernia. 

Injured Intestines.—This, I think, is far more common 
than is generally supposed, and is probably accountable 
for many of the deaths ascribed to ‘colic.’ It is 
occasioned by the mare treading on the abdomen of the 
young animal when it is stretched at sleep. I have seen 
more than one case of the sort where the cause has 
clearly been traced, and it leads me to think that often it 
may occur and not be noticed. After the infliction of the 


224 THE COMMON COLICS OF THE HORSE 


injury the foal is soon taken ill. The pains are slight 
but constant, and the young animal is nearly all the 
time down. If there isno history of the hurt, a mistaken 
diagnosis is really quite excusable, for these small 
creatures show no symptoms definite enough to lead to 
the truth, When present, however, one symptom is 
almost, if not quite, diagnostic—blood-stained feces. It 
is not that dark, coffee-coloured stain so often found 
coating the dung-balls of an adult animal in a case of 
obstinate impaction, but distinct strings of coagulated 
blood mixed with the excreta, 

When diagnosed, little can be done save warn the 
owner of the indefinite state of our knowledge (we have 
no means of ascertaining whether or no the intestine is 
actually vuptuved), and then to rest the animal and the 
bowels as much as possible by the use of sedatives. As 
it may be necessary to continue the sedatives for a day 
or two, it will be found advisable to resort to a com- 
bination of several, and not maintain the administration 
of one drug. Chlorodyne will be found a very good 
agent. Even this, however, may be objected to on the 
ground that it contains such a stimulant as tinct. capsici. 
Perhaps the safest way is to give alternate doses of tinct. 
opii, chloral hydras, and ext. cannabis indice. As far 
as is deemed wise, the foal’s diet should be restricted by 
milking the mare. 

As the foal grows older he is not so likely to allow 
himself to get trodden on in this manner, and yet may 
sustain a similar injury in a different way, ¢.g.: 

One case has come under my notice where the animal, 
when allowed to run out for the first time or two, has 
slipped up violently on to his side during his first pre- 
liminary gambol. ‘This again has produced enteritis and 
led to fatal results. Colic pains always accompany the 


THE TREATMENT OF YOUNG, UNBROKEN ANIMALS 225 


injury, and nothing but a careful inquiry into the history 
will serve to distinguish them from pains proceeding from 
a more simple cause. 

Intestinal Impaction.—Later in the season, as the 
foals grow older, and begin to nibble for themselves, 
uncomplicated cases of subacute intestinal obstruction 
will be met with, occasioned by impaction with im- 
properly digested food. A fairly frequent cause of this 
impaction in foals is the peculiarly dirty habit these 
animals appear to have, when first they begin to pick for 
themselves, of nibbling at mounds of decaying litter, 
dried or rotting vegetation, or even the mare’s excreta. 
This should always be kept in mind, and care taken to 
prevent it where likely to occur. 

It is now that sedatives may be dismissed from the 
veterinarian’s mind, for his case will progress better 
under a stimulative treatment. The animal has attained 
a reasonable size, and his strength will readily allow of 
more active measures being persisted in. With due 
allowance for the dose, he may now be treated exactly as 
the adult—viz., by means of oleaginous purgatives, nux 
vomica, and stimulants. No matter what the diagnosis, 
an enema should always be given for the purpose of 
ascertaining the state of the rectal contents. It is, of 
course, impossible to insert the whole of the hand, and it 
is doubtful whether digital exploration gives information 
enough. 

The necessity for always using the enema syringe was 
forcibly driven home to me some years ago when treating 
a four-months-old foal. He was showing ordinary dull 
pains. I administered the usual medicines, and, more to 
please the owner than with the idea of doing good, pro- 
ceeded to give an enema. The rectum was in a state of 
great impaction. With the injection of each syringeful 

15 


226 THE COMMON COLICS OF THE HORSE 


of water there came away a most abnormal quantity: 
(for so small an animal) of hard pellets of faeces. What 
was more to the point, instant relief was thereby afforded. 
What would have occurred had sedatives been given to 
ease the pains, and the rectum left unexplored, because 
the animal was so small ? : 

Stvangulated Herma.—Lastly, one word of caution 
to the beginner. When called to a case of colic in a 
young colt foal, always lay him down, have the top 
hind limb drawn back, and examine the contents of his 
scrotum. If suffering from hernia, it happens some- 
times that the portion of bowel in the scrotum becomes 
impacted. It is thus unable to pass its contents along, 
and finally becomes strangulated. When present, the 
rupture should be carefully manipulated in order to judge 
of the state of its contents. Should any doubt exist, 
everything in the scrotum should be gently pressed back 
into the abdominal cavity. 

These few scattered remarks on this last subject do 
not pretend to be even an epitome of the treatment to be 
adopted. They simply offer a groundwork on which the 
veterinarian must build up his own methods of practice. 
The subject is yet too indefinite to lay down any dog- 
matic rules upon, and much may be done by future 
writers in contributing to this branch of our literature. 

With this my small work on ‘Colic’ is finished. Ido 
not claim that it is exhaustive, but I do hope that I have 
been successful in placing some matters in such a light 
as to lead to newer lines of thought and fuller investiga- 
tion. 

If we are ever to better our means of diagnosis in these 
troublesome and vexatious complaints, and lead the way 
to a fuller understanding of the more fearsome-sounding 
conditions among them, it will only be by commencing 


THE TREATMENT OF YOUNG, UNBROKEN ANIMALS 227 


at the very beginning. Those cases which are of 
practically every-day occurrence, and which thereby 
come to be treated by somewhat ‘rule of thumb’ 
methods, should be the first to receive our attention. A 
fuller knowledge of their peculiarities would, perhaps, 
prove the stepping-stone to something greater. 

Do not, immediately a horse begins to roll, call it 
‘spasm,’ and forthwith administer an antispasmodic, or 
call it ‘pain,’ and cover it up with a sedative. Some- 
thing more than that is required of the modern veterinary 
surgeon, if he is to enhance the reputation of his pro- 
fession. Nothing should be thought too sinall, nothing 
deemed too insignificant, to aid him in his endeavour for 
honest advance. No amount of theoretical knowledge 
should cause the practitioner (especially the veterinary 
practitioner) to neglect the ‘apparently trivial’ — the 
habit of clinical observation. Even as in the time of 
Percivall, the greatest possible facilities for the further- 
ance of our education are to be found in the sick-box. 
There is still room for careful research, still the need for 
much patient recording of cases, and still alarge amount 
of useful knowledge to be acquired concerning the 
Common Colics of the Horse. 


15-—z 


APPEN Dig 


I. The Composition of Various Foods: Digestive 
Coefficients of Foods. 


THE composition of various foods, as judged by their 
analyses, is usually given in the following terms: 
Moisture - - - - a4 
Fat - : - “ - 


Nitrogenous substances 3 
Carbohydrates een 7 | ~ 


Fibre - - 
Ash - - : * 

A brief description of the above may be of some use: 

Moisture refers, of course, to the water which may 
be volatilized at a temperature of 100° C. (212° F.). 

Fat includes the solid and liquid glycerides of fatty 
acids, composed of carbon, hydrogen, and a little oxygen. 
Fats are soluble in ether. 

Nitrogenous Substances is a broad term, used to 
indicate (usually) all the compounds of a food which 
contain nitrogen. Under this heading are included the 
albuminoids or proteids which have a high feeding value, 
and also frequently the amides, which have only slight 
nutritive properties. They are composed of carbon, 
hydrogen, oxygen, nitrogen, and sulphur, and contain 
about 6°25 per cent. of nitrogen. 

Carbohydrates (Soluble).—Under this heading all 


! For Part I. of this appendix I am indebted to my friend Mr. 
E. Wightman Bell, F.C.S., District Agricultural Analyst for the 
Hoiland Division of Lincolnshire,—H. C. R. 


APPENDIX 229 


those compounds of carbon, hydrogen, and oxygen which 
are soluble in dilute acids and alkalies are included, such 
as sugar, starch, mucilage, pectin, etc. 

Fibre.—The remaining organic constituents which 
are not soluble in the diluted acids or alkalies used by 
the analyst are classed as fibre. The whole of this fibre 
is not indigestible, but the amount capable of digestion 
is very variable, and fibre is consequently usually classed 
as of no feeding value. 

Ash.—This is the mineral or incombustible part of 
food, composed of inorganic salts, a portion of which 
is used for the formation of bone, etc.; but by far the 
greater portion is passed out in the excreta. 

Nitrogenous substances are frequently called ‘ flesh- 
formers,’ whilst fat and carbohydrates are designated 
‘fat or heat formers.’ 

Chemical Composition of Certain Foods.—From 
analyses made by the writer and other analysts, the 
following table shows the 


AVERAGE COMPOSITION OF CERTAIN Foops. 


Clover hay 15°67 | 2°90 11°85 90°56 .| 25°40'| 4°62 
Bran - Sie ta50 |. 3°18 13°68 53°25 G22} 6°18 
Straw(cereal)} 14°19 | 1°53 3°35 36°60 | 40°00 | 4°33 


Nitro- Carbo- 
Moisture.| Fat. genous hydrates | Fibre. | Ash. 
Substances.} (soluble). 

*Wheat 27 225750) -| 1°63 El‘47 67°55 2°7G.| 7-63 
*Barley mip te 24 ~) 5°90 10°50 64°IO R240) 2°OR 
*Oats - ia Ze | ASL 13°53 55°45 8°00 | 2°90 
Maize - sic £r°t2 | 5°20 1040 69°35 2°32 1 161 
*Peas - Pieters | 1°83 23°62 50°00 5°04 | 3°06 
*Beans - iylo'26 | 1°66 26°25 47°36 al 277 
*VYotatoes  -| 75°90 | O°I5 2°EO 19°56 tE2:| 0:07 
"Mangels -| 80°35 | 0'22 5532 6°95 O’91 | 1'25 
Carrots See 2r | 0°20 1°20 8°99 1°45 | 0°95 
Meadow hay | 13’20 | 2'61 8°60 42°99 | 26°75 | 5°85 


I 


* Analyses by the writer. 


230 THE COMMON COLICS OF THE HORSE 


In comparing the feeding value of different foods 
(apart from their ‘ balance’), it is useful to calculate the 
food units which are contained in them. In calculating 
the food units, it is assumed that the moisture, fibre, and 
ash are of no feeding value. Experiments have shown 
that fats and albuminoids produce (practically) two and 
a half times the heat that carbohydrates do; therefore, 
to obtain the food units, we add the percentages of fat 
and nitrogenous substances, multiply the sum by 24, and 
add the percentage of carbohydrates. The result is the 
number of food units. 

Asan example, let us calculate the food units of oats and 
beans from the composition given in the previous table : 


Oats. Beans. 

Fat - - - - 4°81 1°66 
Nitrogenous substances - 13°13 26°25 
17°94 27°91 

Multiply by - - 24 24 
44°35 69°77 

Add carbohydrates - 55°45 47°36 
Food units” - - - I00°30 41733 


It will thus be seen that, if all were digested, the 
feeding value of oats and beans is in the ratio of 
oats 100 and beans 117—that is to say, beans have 
about one-sixth more feeding value than oats; or, 
6 pounds of beans will produce as much heat and energy 
as 7 pounds of oats. 

As these calculations of food units are taken on the 
composition of the food, it follows that the whole of the 
constituents are included, whether digested or passed 
out as manure, their use both as foods and fertilizers 
being taken into account, for, with ordinary care, what 
is not used as food is utilized as manure. 

Digestive Coefficients of Foods.—The composition 


1 J.e., the ratio of nitrogenous to non-nitrogenous foods. 


APPENDIX 231 


of a food as ascertained by chemical analysis is of great 
value in the comparison of foods, and especially of foods 
of the same class. It must not, however, be assumed that 
an animal is capable of digesting the whole, or, in many 
cases, anything approaching the whole, of the nutritive 
constituents. 

The amount digested varies (1) with the kind and 
age of the animal; (2) with the class of food. Ruminants 
naturally digest more of the so-called indigestible fibre 
than horses, so that such foods as grass or hay are of 
greater feeding value for sheep and oxen than for horses. 
In the case of cereals and the leguminous foods, the 
power of digestion of both classes of animals is very 
similar. The following table, drawn up from various 
sources (especial use having been made of the investiga- 
tions of Dr. E. Wolff), shows the 


AVERAGE PERCENTAGE OF DIGESTIBLE CONSTITUENTS 
IN Foops.} 


Albuminous Carbohydrates. Fat. 


Compounds. 

Wheat - ° - Lio 64°0 I°O 
Barley + -s 25 575 I°5 
Oats ° = - 8'o 45'O 4°0 
Maize - - - 8'o 68°5 4°O 
Peas - - - 20°O 52°0 he 
Beans - . - 23°0 50°0 15 
Potatoes - . - 2°O 20°O -~ 
Mangels - > - I‘O 7:0 -~ 
Carrots - - - O'5 70 — 
Meadow hay - - 5°5 40°O I‘O 
Clover hay - - 6°5 35°0 I'5 
Bran - - - 10°5 44°5 2°5 
Straw (cereal) - I°5 40°O I°O 
Linseed cake - : 250 30°0 9°5 
Locust meal - - 2°5 72,'b : 


1 In the above table the figures are only carried to the nearest 
4 per cent, It may be noted that in some cases the amount of 


232 THE COMMON COLICS OF THE Werte 


It has been ascertained that the best balanced diet for 
the horse is one which has an albuminoid ratio of about 
1to 8.1 That is to say, the amount of albuminous com- 
pounds should be about one-eighth of the carbohydrates 
and fat, the latter having been multiplied by 24, as stated 
under food units. 

As an example, let us calculate the albuminoid ratio 
of oats. Referring to table of digestible composition 
(p. 213), we find oats contain: 


Fat, 4 per cent.; carbohydrates, 45 per cent.; and 
albuminoids, 8 per cent. 

4x 24+45=55, which, divided by 8 (albuminoids), 
== 6:9 (nearly). The albuminoid ratio of oats is 
therefore very nearly I to 7. 


Experiments have further shown that a horse of 
1,000 pounds weight, when at rest, requires 8 pounds 
of dry digestible food constituents to maintain it. The 
amount necessary is, of course, considerably increased 
when a horse is at work, and as the average cart-horse 
will weigh over 1,000 pounds, we may Pas the average 
requirement as: 


When at rest, 10 to 12 pounds digestible constituents. 
When moderately worked, 16 to 18 pounds digestible 
constituents. 
When heavily worked, 22 to 24 pounds digestible 
constituents. 
Having an albuminoid ratio of 1 to 8. 


How seldom is the diet varied according to the amount 


carbohydrates is in excess of that given in the first table; this 
is due to digestible fibre being added to the carbohydrates in this 
table. 


' This is about the ratio given by good quality hay. 


APPENDIX 233 


of work to be performed! A common daily feed for cart- 
horses in South Lincolnshire is in winter composed of : 


Corn. - - 14 pounds. 
Cut straw a ae 
Mangels - 2 OE ‘4 


What digestible matter is furnished by a diet of this 
description? ‘To calculate this (and as it is of frequent 
use it may be as well to state it fully) we refer to the 
table of digestible constituents (p. 231), and, taking each 
constituent separately, multiply the percentage by the 
number of pounds of food taken, move the decimal point 
two places to the left (z.¢., divide by 100), which will give 
the number of pounds of that particular constituent in 
the weight of food given. 

For instance, how much digestible albuminous matter 
is contained in 7 pounds of maize ? 

8:0 x 7=56'0+ 100=0'56 pound. 

Working in this way, we find that the diet named 

above has the following feeding value: 


ahem Carbohydrates. Fat. | 
7 pounds maize - - 0°56 4°79 0°28 
7 pounds bran . 0°73 3°12 OrL7 
20 pounds straw - - 0°30 8°00 0°20 
21 pounds mangels - O'2I 18? Ar a 
1°80 17°38 0°65 
x 24 
1°62 
Plus carbo. 
hydrates -| 17°38 
1-80 19°00 


1 This is a mixture of indefinite composition, often consisting of 
equal quantities of bran and maize. 


234 THE COMMON COLICS OF THE HORSE 


This diet, therefore, gives a total digestible feed of 
20°8 pounds, having an albuminoid ratio of about 1 to 
10'5. An average-sized cart-horse, doing a fair day’s 
work, is therefore receiving about the correct quantity 
of total food; but the balance is not good, the albuminoids 
being insufficient. 

An approximately correct diet may be compounded as 
follows: 


Albuminous 


Compounds: Carbohydrates. Fat. 
3 pounds beans - i o 66 1°50 0°04 
4 pounds maize - - org2 2 "74 0°16 
7 pounds bran - - 0°73 3°12 0°17 
20 pounds straw - : 0°30 8°00 0°20 
21 pounds mangels - O'2I 1°47 — 
2°22 16°83 0°57 
x 24 
- 42 
Plus carbo- 


hydrates -]| 16°83 


18°25 


This gives 204 pounds digestible food, with an albu- 
minoid ratio of about 1 to 8:2. It is, therefore, nearly 
theoretically correct, and, being of a compound character 
as regards class of foods, would be an excellent diet. 

It should, however, be noted that these rations should 
be very considerably reduced on non-working days, as 
they are under those circumstances very wasteful, being» 
much in excess of the requirements of the animal, and 
thus giving the horse more work to do to digest it. 

In conclusion, it may be pointed out that it is a very 
simple matter to arrange a diet from the tables given to 
suit any particular case, all that is necessary being to work 


APPENDIX 235 


out from the table the composition of the food suggested 
to be given, and to alter it according as whether it be too 
rich in carbohydrates (in which case a more albuminous 
food should be substituted), or if of too albuminous a 
character, then look out a suitable food of a more starchy 
nature to take the place of one which contains a greater 
quantity of albuminoids or proteids. 


* % # * * 


II. The Use and Abuse of Sedatives in the 
Treatment of the Equine Colics. 

Briefly put, it may be said that the major portion of 
this little monograph is a plea for the more restricted 
use of sedatives in the treatment of the equine colics. 
Seeing that it is more or less a summary of my ideas on 
the subject, and that it contains in a concise form the 
arguments both for and against this practice, I insert 
here the reprint of a paper which I read in 1903 before 
the members of the Eastern Counties Veterinary Medical 
Society. 

% # * * * 

‘There are two factors controlling one’s choice of a 
subject to bring before the members of an Association 
such as this. One is the extent to which it should 
interest the hearers; and the other is the degree of 
special knowledge, fancied or real, the essayist feels him- 
self capable of putting into it. 

The first condition I feel confident I have fulfilled, for 
the treatment of the equine colics is a subject that 
forces itself almost daily upon the average veterinarian ; 
and, unless he feels his present treatment the acme of 
what is right, and all knowledge bearing on it at a stand- 
still, any new line of thought thereon should not fail to 
hold his attention. 


236 THE COMMON COLICS OF THE HORSE 


Of the special knowledge I am able to offer I am not 
so sure. One’s own treatment is so apt to become what 
is popularly termed ‘groovy’; and, taking the line I 
am about to, I expect the discussion that should follow 
to disabuse me of wrong impressions or point out errors 
in judgment that a long-continued practice of a special 
line of treatment may have led me into. 2 

I may say at the outset that I consider the adminis- 
tration of sedatives in colic grossly abused. That in only 
a very, very few instances are they called for at all, and 
that in all other cases their exhibition tends rather to 
prolong the case than bring about its resolution. 

Having taken that standpoint, I shall endeavour to 
give reasons that will justify it. To that end I must 
arrange the matter of my discourse under the following 
headings: 

1. The sedatives in common use, and their generally 
accepted actions. , 

2. Circumstances that have led the veterinarian to their 
frequent administration. 

3. The major points in an argument for their more re- 


stricted use. 
4. Cases of colic in which they are of service. 


5. Cases of colic in which they are harmful. 

The sedatives in common use are opium and its 
alkaloid morphia, belladonna with its alkaloid atropine, 
chloral hydrate, and cannabis indica. 

Taking these in the order named, we shall find that 
opium and morphia, no matter how administered, para- 
lyze cutaneous and mucous structures and the ending of 
sensory nerves with which they are brought into contact. 
Medicinal doses are analgesic and anti-spasmodic, and 
diminish the several secretions, excepting that of the 
skin. We find also, though there is some primary ex- 


APPENDIX 237 


citant action, that they more notably and permanently 
diminish gastro-intestinal secretions and movements. 

Finlay Dun, the author of the work I have taken, 
goes on to state that they are useful in antagonizing 
muscular spasm in spasmodic colic—that when given 
for that purpose they should be combined with aloes, 
oil, or other laxative, to counteract, I suppose, though 
the author does not directly say so, their tendency 
to cause stagnation of the bowels and consequent 
tympany. 

I would draw your attention to the fact that he does 
not advocate them for cases of obstruction, except as 
purely expectant treatment in cases of strangulation, 
intussusception, and obstruction with calculi. Instead, 
he commences his notice of their medicinal uses by say- 
ing emphatically, ‘Opium and morphia are used to 
relieve symptoms rather than the condition on which 
they depend’; and on a later page we find the direct 
statement that ‘opiates are contra-indicated in cases of 
obstinate constipation. The author, by the very 
pointedness of the last sentence, evidently intends it as 
an axiom of treatment, and not as a rough generali- 
zation, 

Belladonna I give second place to because its alkaloid, 
atropine, is so frequently combined with morphia when 
that latter drug is given. In addition to the fact that it 
has, like opium, a primary stimulant and secondary 
paralyzant action, paralyzing sensory nerves and reliev- 
ing pain and sensibility, there is little to note save that it 
diminishes the secretions of all glands—salivary, per- 
spiratory, mucous, and mammary. 

Chloral hydrate is also described as having a primary 
stimulant and secondary sedative action. It is claimed 
for it that it does not stay intestinal movements and call 


238 THE COMMON COLICS OF THE HORSE 


up tympany, nor hinder secretion of the intestinal fluids. 
It is well to remember also that this drug has a marked 
antiseptic action, almost equalling carbolic acid in that 
respect, and that it has an irritant action on the skin 
and mucous membranes. 

Cannabis indica, a deliriant narcotic, anodyne, and 
anti-spasmodic, is said to relieve pain and spasm as 
quickly as opium, but more permanently, and without 
arresting the action of the bowels. 

Circumstances which have led the Veterinarian 
to the Frequent Administration of Sedatives.—Very 
probably the first of these is the idea that anodynes ot 
sedatives invariably relieve cases of uncomplicated spasm 
—that is to say, ‘uncomplicated’ so far as we can judge. 

Next in order we may place the very creditable in- 
stinct that urges man to allay pain and suffering in a 
dumb animal. 

We also find it contended that in colic it is the pain 
that will quickly wear the animal out—that unless we 
relieve the pain the patient will die, not as a direct 
result of the malady he is suffering from, but actually 
from the pain itself. , 

So far as I can gather, those are the arguments ad- 
vanced favouring the frequent use of sedatives in the 
cases we are discussing. I would add to them, however, 
that peculiar fear some practitioners have of witnessing 
a little rolling ; that absolute dread of allowing the 
pains, even as symptoms, to manifest themselves. I 
would even go so far as to state that it is, in many in- 
stances, a fear of his client’s opinion that urges the 
veterinarian to a course he would naturally reason as 
wrong if not unfairly influenced. The client, perhaps, is 
standing by—anxious, alarmed. He suggests that the 
pains should be stayed; wonders they are not. ‘Can 


APPENDIX 239 


nothing be done?’ he may ask. The veterinary surgeon 
is truthfully bound to admit that a dose of a powerful 
sedative will alleviate them. At the same time, he may 
know that, in this particular case, it will not be the best 
treatment possible. He is conscious of the fact that to 
drive that home to the mind of a layman he must give 
a lengthy explanation. He doubts whether, should his 
case go wrong, his explanation would be accepted. He 
wavers. The syringe is produced, and, hoping to please 
his client, the agony is treated instead of the disorder. 
Does not that mean in many cases that the sedative is 
often administered to cloak the practitioner’s want of 
knowledge — administered to hide a pain concerning 
whose cause there is blind ignorance ? 

Again, those who have given this subject much thought 
are almost certain to come to the conclusion that the 
‘dread of enteritis’ often wrongly influences the prac- 
titioner to the administration of an anodyne. In the 
horse we have, in enteritis, a form of colic that is, per- 
haps, apart from contagiousness, only equalled in human 
medicine by cholera. Its rapid fatality, when once set 
in, is appalling. With one or two recent cases of that 
description uppermost in his mind, the veterinarian at 
once pushes the administration of sedatives in his next 
case of acute abdominal pain. And yet he may be doing 
wrong. I hold the opinion, rightly or wrongly, that 
enteritis as we know it is a form of acute septic infection 
of the blood-stream, commencing from the intestines, 
with a cause as yet undiscovered. And if, until I see 
its fatal signs well in evidence, I withhold the adminis- 
tration of sedatives in a case of colic, I always console 
myself with the fact that their earlier exhibition would 
not have helped in the least to bring about a favourable 
issue. 


240 THE COMMON COLICS OF THE HORSE 


Allowing these influencing circumstances to have 
arisen solely from the veterinarian’s own experiences, 
{ fear we have another set of reasons impelling the 
veterinary practitioner to a use of sedatives that is not 
only extreme, but sometimes fatal, He sees or hears of 
their frequent use in human medicine for apparently like 
disorders, and argues, falsely in this case, that what is 
good for man is good for beast. Reasoning from analogy 
never led man to greater error. If we do so here, we 
simply cast aside all our knowledge of the special 
anatomy of the patient with which we are dealing, throw 
to the winds all our special information regarding his 
peculiarities in physiological functions and processes, and 
follow as mere automatons whatever human medicine 
says is right. The practitioner of human medicine is 
right in his own case. It does not follow that if we do 
as he does we are right in ours. 

Major Points in an Argument for the more 
Restricted Use of Sedatives in Colic.—Allowing for 
the moment that sedatives will relieve uncomplicated 
spasm, I would put these two questions to the members 
here present. How often is it that we are called in toa 
case of simple spasmodic colic? If we are, can we abso- 
lutely and with certainty distinguish it at once from a 
spasm due to some more serious cause ? 

In the first place, most of you will agree with me when 
I say that the case of uncomplicated spasm usually gives 
way to some first remedy administered by the owner ; 
that when we see spasm it is a spasm of some hours’ 
duration, and therefore due to some fairly serious cause, 
In other words, we are called in to a case of simple 
spasmodic colic seldom or never, and have, therefore, no 
reason to administer a sedative at all. 

Secondly, I think you will again agree with me when 


APPENDIX 241 


I say that our present means of differentiation do not 
allow of our attending a case of colic and giving a 
diagnosis off-hand. That, therefore, even if we are called 
in early, and assume it to be a case of simple spasm, the 
early administration of a sedative will not be wise. The 
spasm may turn out to be due to fecal obstruction, in 
which case the anodyne will do harm rather than good. 

This all seems to call for some definition of the words 
‘uncomplicated spasm’; but I venture to think that any 
one of your here, when discussing the equine colics, would 
hesitate to give those words a definite limitation. Given 
a quickly occurring case of colic which an anodyne 
rapidly relieves, the practitioner is only too apt to care- 
lessly pass it over as ‘spasm,’ without a due inquiry as 
to a possible ‘ something’ of which the spasm may have 
been only the result. 

If we admit that spasm, or sudden painful contraction 
of the intestinal muscular coats, comparable with the 
ordinary cramp of voluntary muscle, is likely to occur, 
then the name of simple spasmodic colic may still be 
retained in our nomenclature. In granting that, how- 
ever, we grant a great deal. We admit that this sudden 
cramp may occur as a result of continued or excessive 
work, as a result of cold or other equally indefinite cause, 
quite independent of there being in the intestinal tube 
poisonous materials generated from the ingesta. We 
admit that we do not attempt to explain the cramp asa 
result of the presence of food, whose very bulkiness or 
indigestibility brings it about. We allow that no tem- 
porary malarrangement of the intestines themselves may 
be blamed. 

Can we allow all this? I[ doubt it. Rather would I 
suggest that what we now call a case of simple or 
uncomplicated spasm is one in which the materials or 

16 


242 THE COMMON COLICS OF THE HORSE 
conditions giving rise to it are small in potency or 
seriousness, and are quickly antagonized by a sharp, 
quick effort on the part of the bowel, the painful mani- 
festation of which we term ‘spasmodic colic.’ The very 
fact of the cause mot being a serious one allows a sedative 
to be given. The cause of the mischief is removed by 
the bowel, while the sedative dulls the outward manifesta- 
tion of the pain. In this case the bowels act im spite of 
the sedative. When the cause zs a serious one, then this 
does not apply. The bowel then, hindered in its actions 
by the administration of the anodyne, fails to act as in 
the simpler case, and an obstinate condition of intestinal 
stasis is bound to result. As we cannot always say at 
the outset of a case whether or no the cause 7s a simple 
one, then sedatives had better be withheld entirely. 

Having thus disposed of the value of sedatives in 
simple spasm—which, after all, is the main argument to 
be advanced in their favour—we come to several circum- 
stances that absolutely negative their use in other forms 
of colic. Before an assembly of practical men I need 
not dwell over them long. We all know the enormous 
length of the horse’s intestines and the large masses of 
food they are called upon to deal with. We know that 
the amount of nutritive material abstracted from the 
large masses of food taken in is comparatively small, 
and that, therefore, the great bulk of the indigestible 
matter has to be kept on the move towards its exit from 
the body, in order to make room for further supplies. 
This brings us to the known fact that the horse requires 
to pass eight to ten or twelve motions daily to maintain 
his health, and that stoppage of his peristaltic action for 
twenty-four hours is about equivalent to something like 
eight to ten days in man. 

This, if I may be allowed to mention what I have 


APPENDIX 243 


before published, should lead us to easily understand why 
it is that pain follows so rapidly on apparently slight 
stasis of the bowels in the horse. It is this that renders 
equine colics of such serious importance. It explains in 
great measure the rapid and oftentimes fatal course 
they run, and impressively points out the urgent neces- 
sity for prompt and precise remedial measures. This, 
more than anything else, should induce the veterinarian 
to carefully weigh his data before jumping at a diag- 
nosis. Above all, it should cause him to deliberately 
ponder, and perhaps stay his hand, before administering 
those agents which tend to kill pain, but at the same 
time tightly lock the bowels. It should cause us to 
reason that though sedatives may be administered with 
comparative impunity to man, anything that may tend 
to stagnate the bowels, which a sedative undoubtedly 
will, is not to be exhibited with safety to the horse. 

To those who administer sedatives with the humane © 
object of alleviating pain I have only one remark to 
make. Their first duty is to preserve life, even if in so 
doing they inflict a little more suffering. 

Then consider the nature of the horse’s food. It is 
such that, if locked for any length of time within the 
bowels, it quickly gives rise to the formation of gas. In 
conjunction with that fact reflect that the food so liable 
to act is present in large quantities, and we see that this 
formation of gas will be extensive. Anyone who has 
seen the amount of tympany called up by a dose of opium 
or morphia will bear me out in that. 

We should next pause for a moment over the question 
of tympanitic stomach—that condition in which the 
stomach is abnormally distended with gas that is gaining 
no outlet from the pylorus. As veterinarians we know, 
without entering into details, that there is an arrange- 

16—2 


244 THE COMMON COLICS OF THE HORSE 


ment of the fibres of the cardiac end of the stomach 
walls rendering the eructation or belching up of the gas 
by road of the cesophagus an utter impossibility. It 
must gain exit from the body by way of the intestines 
and rectum, or accumulate in the stomach to the extent 
of causing rupture of that organ and death. Given the 
gas formation, and we have here a direct danger in the 
administration of a sedative, a danger entirely dependent 
on the anatomy of the horse’s stomach. We lock the 
natural outlet, namely, the intestines, and the gases 
accumulate in the stomach to a degree that is dangerous. 

I may be met with the argument that two of the seda- 
tives I have mentioned (chloral hydrate and cannabis 
indica) do not arrest the action of the bowels. To that 
I have this reply: Those two certainly are not the 
sedatives in common use among veterinarians. Opium 
and morphia, and belladonna and atropine, with their 
dangerous effects, easily run a good first. Putting that 
on one side, I feel it hard to concieve of a drug which, 
while diminishing pain and sensibility in any organ, yet 
fails to influence in some degree or other that organ’s 
movements. Chloral hydrate and cannabis indica may 
not, to the extent of opium and belladonna, unfavourably 
affect peristalsis. Yet no one will deny that they come 
under the same class of drugs, and must, in common 
parlance, be ‘tarred with the same brush.’ 

There is another consideration, this time a selfish one, 
that should concern the veterinarian when contempla- 
ting the use of a sedative in colic. He should remember 
that to a very great extent—an extent hardly realized 
by those who constantly use them—anodynes effectually 
mask the symptoms of the animal’s complaint. In words 
I once heard, ‘There is no real art in relieving pain. 
Anyone with a few grains of morphia and a hypodermic 


APPENDIX 245 


syringe may do that. If possible, the cause of the pain 
should be the first consideration.’ If the veterinarian 
persists in the administration of analgesics in equine 
colic, he cannot expect his powers of diagnosis to 
advance. There is yet so much to learn concerning 
these troublesome disorders that we absolutely cannot 
afford to throw away our chances of acquiring furthet 
knowledge. And yet that is what we do when we 
administer an anodyne. In these cases the only evidence 
we may read is that derived from the symptoms the 
animal will show. Hide these by a dose of morphia and 
we are face to face with a closed book. If I may carry 
the metaphor still farther, its pages are often closed 
beyond our power to reopen. 

To those who still remain unconvinced I have, in 
favour of the general correctness of my conclusions, one 
last proof to offer, and it is one that might well be 
termed a ‘facer.’ It is this. For the last seven years I 
have altogether abandoned sedatives in the treatment of 
colic, with the best results. Instead, I have relied on 
large doses of ammonium carbonate and nux vomica, 
aided by what other stimulant the cases appeared to 
demand. ‘The details of that treatment I need not enter 
into here. During the whole of those seven years I have 
seen no cause to regret the change, My cases are not so 
long about, are easier diagnosed, and do not cause the 
same amount of anxiety, while my list of fatalities has 
decreased to an eminently gratifying extent. If it is any 
inducement, I can promise the same happy state of affairs 
to those who may follow the same road. 

Though these by no means exhaust the arguments that 
might be advanced against the extensive employment of 
sedatives in the equine colics, the time at my disposal 
does not permit of their further mention. I think, how- 


246 THE COMMON COLICS OF THE aise 


ever, that I have now said enough to lead those here who 
have been in the habit of so using them to give the sub- 
ject even more careful thought than they hitherto may 
have done. 

Cases of Colic in which Sedatives are of Service. 
— Without venturing the rash statement that a sedative 
is never of use in an attack of colic, I still give it as my 
firm opinion that those cases in which it may be used 
with any gveat advantage are extremely few and far 
between. I will mention the chief. ; 

First in many practices will come the colic accompany- 
ing superpurgation from a dose of aloes. There no 
difference of opinion can possibly exist. In addition to 
other remedies, a dose of crude opium or a hypodermic 
dose of morphia is urgently called for, and, assuming the 
case not to have advanced too far, it is attended with 
good results. Even then a certain amount of tympany 
will often result, which, however, quickly gives way toa 
suitable stimulant treatment. 

Next in order of importance will come that form of 
colic arising from the ingestion of irritating foods, as, for 
example, new oats, mouldy or mow-burnt hay, or frozen 
roots, in which purging is a prominent symptom. We 
have in that an excited and irritated condition of the 
bowel, with peristalsis in evidence beyond the normal, 
and a sedative that does not too actively abate the peri- 
stalsis may, perhaps, be given with benefit. At any rate, 
it will stay the immediate pains. 

Here, however, the point may be raised as to whether 
this purging is not a simple effort of Nature to relieve 
the system of the offending material. It might even be 
contended that, rather than check her, she should be 
assisted in so relieving herself by the administration of 
some mild diffusible stimulant combined with a bland 


APPENDIX 24” 


oleaginous laxative. In using the sedative there is 
always the risk of slightly over-estimating the correct 
dose for the purpose, thereby staying the action of the 
bowels just a trifle too far, and bringing about a case of 
intestinal tympany from the fermenting ingesta within. 
Though the tympany called up in this manner can 
hardly be regarded as serious, it is questionable whether 
the treatment has been a rational and a scientific one. 
As the case, then, is just a little open to question, I give 
the supporters of sedatives the benefit of the doubt, and 
allow that an anodyne will, in this instance, relieve the 
pain without doing serious harm. 

Peritonitis is another, though less frequent, form of 
colic that will benefit by the administration of an anal- 
gesic. So far I have met with only one or two isolated 
cases, one of which resulted from the use of the trocar 
and cannula in a case of intestinal tympany. Even here 
a sedative, as we generally understand a sedative, is not 
going to be the most suitable remedy. Aconite, with its 
powers of rapidly reducing the pulse-beats, lowering the 
temperature, and lessening the perceptions of pain, will 
be found the most beneficial. 

We now come to another mention of enteritis, that 
bogey of the veterinarian, and the cause of certainly 
more than half of the mistreatment of veterinary colic. 
When once diagnosed, of course sedatives may be given 
with a lavish hand in order to deaden the agonizing 
pains that assuredly herald the animal’s speedy death. 
But that which is diagnosed as enteritis—is it always 
enteritis ? Those among us of any length of experience, 
as they call to memory the cases of their earlier days, 
are bound to admit that it is not. More especially to 
the young beginner will this hoary-headed misnomer 
rear his grinning features and rattle his clanking chains, 


248 THE COMMON COLICS OF THE HORSE 


Confronted with a case of acute agonizing pain, the 
young graduate becomes alarmed. Enteritis, with all 
the tales of dread fatality its name calls up, flits across 
his mind. His case is—he is certain it is—entevitis. He 
commences at once the administration of sedatives. 
What is the result? Everyone knows that a case of 
subacute intestinal obstruction may commence with 
extremely acute symptoms, and then linger on with dull 
pains for days. What in reality was the sharp paroxysm 
denoting a belated attempt of the bowel to deal with 
a mass of obstructive matter has been treated with an 
anodyne, the bowel being thus deadened to the serious 
nature of its condition, and the gravity of the case of 
obstruction rendered a certainty. 

Were it a proved fact that the administration of seda- 
tives would bring about resolution in a case of this so- 
called enteritis I could find some excuse for this error. 
If one case only, and that an unquestionable one, were 
on record of a cure being so brought about, I would again 
risk falling into that error myself. But it is not so. 
There is not, and never has been, an instance in which 
sedatives have had a beneficial action and changed the 
issue in an undoubted case of enteritis. If only that 
teaching were generally accepted, acute pain would not 
then frighten the practitioners into the too early adminis- 
tration of anodynes, and one great factor leading to their 
abuse in the treatment of colic would be entirely done 
away with. 

Cases of Colic in which Sedatives are Harmful. 
—Among the abuses of sedatives there is, to my mind, 
nothing worse than the case of their administration in 
subacute obstructions of the colon. These are the cases 
that form so large a percentage—probably 80 or go— 
of our total attacks of colic, so that if in his treatment he 


APPENDIX 249 


is labouring under a misapprehension, the practitioner 
will have the great bulk of his cases suffer, and not the 
comparatively few. The very thing we are called upon 
to treat in these cases is a lethargic, torpid condition of 
the bowel, and, unless we are homceopaths, believing in 
the dictum simila similibus curantur (let likes be treated 
by likes), we cannot, with any regard for logic, administer 
an anodyne. 

Those who have met with them will have noticed that 
obstructions confined to the single colon give rise to a 
condition of the bowel even more obstinately torpid than 
that arising from a like affection of the larger bowel, 
in which case a sedative is even more strongly contra- 
indicated still. 

In justice to those who give anodynes in these cases, 
it is only fair to add that they administer at the same 
time a drastic purgative in the shape of aloes. They 
say in support of their treatment that an anodyne will 
stay the pains while the purgative removes the cause— 
viz., the obstruction. In so believing they lull them- 
selves into a state of false security. The anodyne, in 
addition to staying the pain, stays the action of the aloes 
and the bowels. In this way the cause is still retained, 
and the case prolonged or even aggravated. 

Gastric tympany I have already touched on, and have 
pointed out that the arrangement and anatomy of the 
horse’s stomach, when it is filling with gas, will not allow 
of any agent being given that will tend to stay the normal 
movements of the intestines. | 

In tympanites confined to the intestines themselves 
sedatives are just as dangerous. ‘This is another form of 
colic due to the ingestion of irritating and fermenting 
foods, this time unaccompanied by a relieving purge. 
The volume of gas distends the intestine to a point of 


250 THE COMMON COLICS OF THE HORSE 


agonizing pain, may even, by force of pressure, interfere 
with the movements of the lungs, bringing about a 
deoxygenated state of the blood, or even a species of in- 
toxication from the absorption of the gas itself. Nothing 
but a speedy removal of the gases from the system 
will restore the body tone to a state competent to fight 
against the disorder. A sedative will not remove but 
lock them there, at the same time causing the retention 
within the intestines of the very matter from which the 
gases are arising. 

Throughout this paper it will be noticed I have re- 
frained from mentioning such forms of colic as volvulus, 
intussusception, the action of poisons, parasitic embolism 
of the mesenteric bloodvessels, etc. I do not think 
these cases occur with such a frequency as should lead 
us to confound their treatment with that of the more 
simple forms. The fact that a sedative is needed by 
conditions thus serious should not cause us to aimlessly 
blunder forward, sedative in hand, to every case of colic 
we encounter. 

This, gentlemen, concludes my plea for the more cau- 
tious and restricted use of sedatives in the treatment of 
the equine colics. I cannot claim that I have covered 
the whole of the ground the title of my paper would 
suggest, or that I have said even one quarter of what 
might be said on this very important subject, for it is 
extremely difficult—nay, impossible—to condense within 
the limits of a single paper the whole line of reasoning 
that leads one to a conclusion invoiving this so radical 
a change in our therapeutic methods. I can only pre- 
tend to have given you the merest outline. In any case 
‘where they think I have been too self-assertive or too 
dogmatic, I wish my hearers to fully understand that 
dogmatism does not necessarily imply arrogant self- 


APPENDIX 251 


conceit, or even the assumption of a superior knowledge. 
In this case it means that the speaker thinks he has 
placed his fingers on a weak spot in the generally ac- 
cepted treatment of a certain set of complaints. It means 
also that towards anything approaching an innovation 
he dimly detects a certain degree of apathy among his 
fellow-practitioners, and recognises that a certain amount 
of plain speaking is the one thing calculated to stir them 
into wakefulness concerning it. 

If in coming here I make but one convert, I shall feel 
the time has been well spent. If, again, the discussion 
proves certain conclusions of mine to be wrong, or shows 
where my enthusiasm for a new thing should be moderated, 
my time will have been even better spent.’! 


III. Further Remarks on the Use of Aloes in the 
Treatment of Intestinal Impactions. 


In this, the second edition of this little book, pub- 
lished in 1909, I wish to qualify the strictures placed on 
aloes in the earlier edition. Since the first publication of 
this work in 1902 my views concerning the use of this 
drug in the treatment of the equine colics have become 
somewhat modified, and I should not be honest did 1 
not here admit the change. 

At first I contemplated re-writing the matter occurring 
under this head in the several places in this book. For 
one or two reasons, however, I prefer to let it stand, and 
give explanation here. In the first place, the reader 
will be able to compare what has been written before 
with the remarks I have now to make. Secondly, the 
matter on pages 96 and 97 and in Chapter XVII. 
contains so much that is true that it should be allowed 


1 The Veterinary Record, March 21, 1903. 


252 THE COMMON COLICS OF THE HORSE 


to remain, if only to serve as a reminder that the use of 
aloes should be tempered with the greatest caution and 
judgment. 

The most serious objection I saw at that time to the 
employment of aloes was that its early administration in 
cases of intestinal obstruction prevented me from after- 
wards persisting in the vigorous stimulant treatment I 
deemed those cases necessitated. What I always feared 
was that a stimulant treatment following close on the 
administration of aloes should induce a fatal attack of 
superpurgation (see Chapter XVII.). 

So grave an objection did I find this that I altogether 
discarded aloes, and for several years used only linseed 
oil, this, to my mind, being a safer and less drastic 
method of bringing about the requisite softening of the 
bowel contents. In a great many cases, in fact, I used 
no aperient at all, but relied solely on the stimulants. 

From this last statement I hope it will not be inferred 
that I believe the one half of a correct method of treating 
intestinal obstruction to consist in withholding aperients 
altogether. What I have published before will show 
that not to be the case. Such a method, in fact, would 
be irrational to a degree, and I only practised it in a 
long series of cases in order to quite convince myself 
that the stimulant treatment which I so _ strongly 
advocated was based on a sure foundation. 

It speaks much for the rationality of that treatment 
that for quite a long while I was able in this manner to 
deal successfully with cases of obstinate impaction. That 
I was successful I proved to myself by making a practice 
for some considerable time of attending the post-mortem 
of every case I had die from ‘colic.’ Practically no 
death occurred which I was unable to trace to some 
other cause very much more grave than that of mere 


APPENDIX 253 


obstruction, the most common cause of all being that 
of twist or serious displacement of the double colon. 

Once that point was proved, I was open again to 
include in my list of remedies any aperient that could 
be safely used in conjunction with what was to me the 
major portion of the treatment. Always I had seen that 
the administration of the linseed oil, although successful, 
was ‘inconvenient,’ and not infrequently attended with 
difficulty, as, for instance, in an animal awkward to 
drench. I thereupon determined to give aloes a further 
trial, if only on account of the greater ease with which 
it might be administered. 

Seeing that I had proved to myself I could dispense 
with any aperient at all, and that without serious 
prejudice to the patient I was treating, I resolved to 
commence with quite small doses. Accordingly, I 
started with a dose which many in the habit of pre- 
scribing aloes regularly would deem absurd. Gradually 
I raised it, however, until I arrived at the maximum 
dose which I found could be administered simultaneously 
with full doses of stimulants. 

This dose I found for a gross, heavy cart animal, 
suffering from impaction, to be six drachms. For a nag 
in the same condition, I found five drachms to be equally 
sufficient. [hese doses, although acting freely at times, 
do not always create that excessive evacuation the 
average stableman likes to see. They prove amply 
sufficient, however, to favourably influence a case of 
obstruction, and that with safety. 

We may sum up, then, as follows: In dealing with 
intestinal impaction in the horse, the stimulant treatment 
(which excludes the use of any sedative whatever) is not only 
logical in theory, but bears the test of actual practice. 
At the same time there should be exhibited an aperient, 


254 THE COMMON COLICS OF THE HORS# 


sufficiently powerful to favourably influence intestinal 
secretion, but not of such potency as to prevent an active 
stimulant treatment being afterwards adopted. Of these 
we have the choice of two that are equally reliable. 
One, linseed oil, mild in its action, may be used freely, 
without fear of untoward result. The other, aloes, must 
be used with comparative caution. 

The strictures heretofore placed on aloes must therefore 
be read in the light of this later experience. That their 
circulation in the earlier edition of this book has served 
to point out to others the value of a solely stimulant 
treatment I am in the happy position of being fully 
assured.t For that reason, and that they may, perhaps, 
serve the same purpose again, I have allowed them to 
stand. Simply, I tack on this addendum and give the 
practitioner, with his case before him, and with the 
advantages and disadvantages of either method duly 
weighed, the onus of making choice. 

After all is said and done, the question as to which of 
two aperients one should use is only a detail of minor 
importance in that treatment of equine intestinal impac- 
tion which it is the main motif of this book to advocate. 
That treatment this qualification concerning aloes is not 
intended to affect at all. 


1 See Preface to the Second Edition. 


INDEX 


ABDOMEN, surgical regions of, 6 =| Cause of pain in intestinal impac- 
Abdominal incision, position of, tion, 93 
in laparo-enterotomy, 177 Causes, anatomical predisposing, 
organs, tabular arrangement of colic, 29, 30 
of, 15 of enteritis, 203 
Aloes and opium inadvisable in of gastric impaction, 48 
intestinal impaction, 96, 102 tympany, 54 
in intestinal impaction, 96 of intestinal tympany, 189 
Ammonium carbonate in intestinal of ruptured stomach, 73 
impaction, 98 of subacute obstruction of the 
hydrate in gastric tympany, 66 double colon, 82 
Anatomical predisposing causes of pelvic flexure of the colon, 
enlic, 29, 30 124. 
Anatomy of the stomach, 8, 17 single colon, 137 
Antizymotics in gastric tympany, small intestines, 147 
67 of superpurgation, 213 
intra-intestinal injection of, in physiological predisposing, of 
tympanites, 197 colic, 28,. 31 
Auscultation, 25 — Caution against use of sedatives, 
31, 68, 102, 2Io 
Bowel, incision and suture of, 179 in gastric tympany, 68 
puncturing for intestinal tym- | Chloral hydrate in intestinal im- 
pany, 193 paction, 103 
Bowels, inflammation of, 200 in superpurgation, 216 
stoppage of, 80 Classification of equine colics 
(Friedberger’s), 2 
Calculus in small colon, 187 Colic, anatomical predisposing 
Cardiac sphincter, illustration of, causes of, 29, 30 
17,38 59 caused by intestinal septic 
Care in diagnosis, 21 infection, 45, 203 
Case of gastric tympany, 69 comparison of human with 
Cases of subacute obstruction of equine, 4, 32 
double colon, 108, 122 flatulent, 189 
small intestines, 156, 157 Friedberger’s classification 
Cause, exciting, of intestinal im- of, 2 
paction, 93 its derivation, 1 


2)? 


256 _ THE COMMON COLICS OF THE HORSE 


Colic, physiological predisposing 
causes of, 28, 31 
treatment of, in foals, 221 
in yearlings and_ two- 
ear-olds, 219 
Colon, calculus in small, 187 
intestinal irrigation in obstruc- 
tion of, 161 
the, 13 
single, 14 
Comparison of human with equine 
colic, 4, 32 


Danger in over-ripe grasses, 48 
of sedatives in gastric tym- 
pany, 68 
Definition of enteritis, 200 
of gastric impaction, 47 
tympany, 52 
of intestinal tympany, 189 
of ruptured stomach, 73 
of subacute obstruction of 
double colon, 80 
pelvic flexure of the colon, 
123 
single colon, 137 
small intestines, 147 
of superpurgation, 213 
Derivation of colic, 1 
Diagnosing, history of case in, 
22 
Diagnosis, care in, 24 
of enteritis, 206 
of gastric impaction, 50 
tympany, 59 
of intestinal tympany, I91 
of ruptured stomach, 76 
of subacute obstruction of 
double colon, 86 
pelvicflexure ofthe colon, 
131 
single colon, 142 
small intestines, 152 
of superpurgation, 215 
respiratory movements in, 23 
Diagrams of incisions in operation 
of laparo-enterotomy, 177, 178 
Diarrhea, treatment of, in young 
animals, 222 
Dilatation of the stomach, 52 


Domestication an exciting cause 
of colic, 35 7 
Double colon, cases of subacute 
obstruction of, 108, 122 
subacute obstruction of, 80 
Duodenal S-trap, 10, 11 


Enteritis, 200 

causes of, 203 

definition of, 200 

d‘agnosis of, 206 

piognosis of, 208 

sedatives in, 209 

symptoms of, 205 

treatment of, 209 

or intestinal septic infection, 


20 
Hnigrocenieee in intestinal tym- 
pany, 192 
seat of, 194 
Equine colic compared with 


human, 4, 32 
Errors in stable-management pro- 
ductive of colic, 36 
Eructation in gastric tympany, 58 
Eserine in intestinal impaction, 
100, 144 
value of, in gastric tympany, 
69 
Examination of the patient, 21 
Exciting cause of colic, domestica- 
tion an, 35 
food as an, 36 
water as an, 37 
of intestinal impaction, 93 
Exploration, rectal, 26 
External incision in laparo-entero- 


tomy, 177 


Flatulent colic, 189 

Foals, treatment of colic in, 221 

Food as an exciting cause of colic, 
36 

Friedberger’s classification of 
equine colics, 2 


Gases present in gastric tympany, 
05 

Gastrectasis, 52 

Castric impaction, 47 


INDEX 


Gastric impaction, causes of, 48 
definition of, 47 
diagnosis of, 50 
prognosis of, 50 
symptoms of, 49 
treatment of, 50 
Gastric tympany, 52 - 
ammonia in, 66 
antizymotics in, 66 
case of, 69 
causes of, 54 
danger of sedatives in, 68 
definition of, 52 
diagnosis of, 59 
eructation in, 58 
gases present in, 65 
hydrate of iron in treatment 
of, 66 
prognosis of, 64 
symptoms of, 56 
treatment of, 65 
vomition in, 59, 65 
Gorged stomach, 47 
Grass staggers, 47 
Grasses, danger in over-ripe, 48 


Heredity a predisposing cause of 
colic, 33 

Hernia, strangulated, in young 
animals, 226 

Hindrances to vomition, 29, 30 

History of case in diagnosing, 
22 

Hoven, 53 . 

Human compared with equine 
colic, 4, 32 

Hydrate of iron in treatment of 
gastric tympany, 66 


Impaction, gastric, 47 
causes of, 48 
definition of, 47 
diagnosis of, 50 
prognosis of, 50 
symptoms of, 49 
treatment of, 50 

Impaction, intestinal, 80 
exciting cause of, 93 
in young animals, 225 
of double colon, 80 


257 


Impaction of pelvic flexure of the 
double colon, 123 
of single colon, 137 
of small intestines, 147 
sedative treatment of, 89, 102 
stimulant treatment o*. g2, 
143, 154 
Incision and suture of bowel, 


179 
Inflammation of the bowels, 200 
Influence of time of day on pro- 
duction of colic, 43 
Injection, intra-intestinal, of anti- 
zymotics in tympanites, 197 
Inspection of patient, mode of, 21 
preliminary, in young animals, 
220 
Intestinal impaction, aloes in, 96 
ammonium carbonate in, 98 
cause of pain in, 93 
chloral hydrate in, 103 
eserine in, 100, 126 
exciting cause of, 93 
in young animals, 225 
nux vomica in, 99 
reasons against use of seda- 
tives in, 102 
sedative treatment of, 89, 102 
Stimulant treatment of, g2, 
143, 154 | 
turpentine 1n, 100 
Intestinal irrigation, case treated 
by, 162, 169 
in obstructions of the colon, 
161 
obstructions, surgical treat- 
ment of, 173 
septic infection a cause of 
colic, 45, 203 
of enteritis, 203 
Intestinal tympany, 189 
causes of, 189 
definition of, 189 
diagnosis of, 191 
enterocentesis in, 192 
prognosis of, 192 
puncture of bowel in, 192 
sedatives in, 199 
symptoms of, 190 
treatment of, 192 


17 


258 THE COMMON COLICS OF THE HORSE 


Intestines, the large, 12 
the small, 11 
impaction of the, 80 
Intra-intestinal injection of anti- 
zymotics in tympanites, 197 
Iron, hydrate of, in treatment of 
gastric tympany, 66 


Kidneys, the, 15 
Knisely’s stomach-tube, 71 


Laparo-enterotomy, diagrams of 
incisions in, 177, 178 
materials required for opera- 
tion of, 174 
preparation of materials re- 
quired for, 175 
Large intestine, 12 
Lembert’s sutures, 180 
Liver, the, 14 


Materials required for the opera- 
tion of laparo-enterotomy, 174 

Methods of watering horses, 38 

Mode of inspection of patient in 
colic; 21 

Morphia in superpurgation, 216 


New oats as cause of: gastric 
i hagid ena Ns a Oa a 

Nux vomica in intestinal impac- 
tion, 99 


Oats, new, cause of gastric tym- 
pany, 54 
Obstruction, case of, treated by 
intestinal irrigation. 162, 169 
Obstruction of small intestines, 
cases of, 156, 157 
causes of, 146 
definition of, 146 
diagnosis of, 152 
prognosis of, 153 
purging in, 150 
rectal exploration in, 150 
symptoms of, 148 
treatment of, 153 
Obstruction of the colon, intestinal 
irrigation in, I61 
Obstruction, subacute, of double 
colon, 80 


Obstruction, subacute, of double 
colon, causes of, 82 
definition of, 80 
diagnosis of, 86. 
prognosis of, 88 
symptoms of, 83 
treatment of, 89 


Obstruction, subacute, of single 
colon, 137 
Obstruction, subacute, of small 


intestines, 147 
Obstruction, subacute, of pelvic 
flexure of colon, Ras 
causes of, 124 
definition of, 123 
diagnosis of, 13% 
prognosis of, 133 
symptoms of, 129 
treatment of, 134 
Obstructions, intestinal, 
treatment of, 173 
CEsophagus tube in gastric tym- 
pany, 71 
Operation of laparo- enterotomy, 
177 
Opium in superpurgation, 257 
Opium and aloes in intestinal im- 
paction, reasons against, 96, 103 
Over-ripe grasses, danger in, 48 


surgical 


Pain, cause of, in intestinal im- 
paction, 93 

Pancreas, the, 14 

Paralysis of rectum, 139, 143 

Passage of food through the diges- 
tive canalof horse, time occupied 
in, 314 

Patient, mode of inspection of, 21 


Pelvic flexure of colon, subacute 


obstruction of, 123 

Percussion in diagnosis, 27 

Peritoneum, the, 8 

Physiological predisposing causes 
of colic, 28,35 

Physostigmine in ee im- 
paction, 100, 135, I 

Position of abdominal tation in 
laparo-enterotomy, 177 


. Predisposing, anatomical, causes 


of colic, 29, 30 


INDEX 7 250 


Predisposing, physiological, 
causes of colic, 28, 31 

Preliminary inspection when diag- 
nosing in young animals, 220 

_ Preparation of materials for opera- 
tion of laparo-enterotomy, 175 

Prevention of ruptured stomach, 


79 
Prognosis of enteritis, 208 
of gastric impaction, 50 
tympany, 64 
of intestinal tympany, 192 
of ruptured stomach, 78 
of subacute obstruction of 
double colon, 88 
pelvic flexure of double 
colon, 133 
single colon, 143 
small intestines, 153 
of superpurgation, 216 
Pulse, the, 24 
Puncturing the bowel in intestinal 
tympany, 193 
Purgative, aloetic, in intestinal 
impaction, 89, 96 
Purging in subacute obstruction 
of the small intestines, 150 


Reasons against use of sedatives 
in intestinal impaction, 32, 102 
Rectal exploration, 26 
in subacute obstruction of 
small intestines, 150 © 
Rectal paralysis, treatment of, 143 
Rectal tube, Smith’s, 146, 162 
Respiratory movements in diag- 
nosis, 23 
Ruptured stomach, 73 
causes of, 73 
definition of, 73 
diagnosis of, 76 
prevention of, 79 
prognosis of, 78 
symptoms of, 74 


S-trap, duodenal, ro, 11 
Seat of enterocentesis, 194 
Sedatives, caution against use of, 
31, 68, 102, 210 
in enteritis, 209 


Sedatives in gastric tympany, 68 
in intestinal impaction, 809, 
102 
in intestinal tympany, 199 
in superpurgation, 216 
Septic intestinal infection as cause 
of colic, 45, 203 
Single colon, subacute obstruction 
of, 136 
causes of, 136 
definition of, 136 
diagnosis of, 142 
prognosis of, 143 
symptoms of, 139 
treatment of, 143 
Single colon, calculus in, 187 
Small intestines, 11 
subacute obstruction of, 147 
cases of, 156, 157 
causes of, 147 
definition of, 147 
diagnosis of, 152 
prognosis of, 153 
purging in, 150 
rectal exploration in, 150 
symptoms of, 148 
treatment of, 153 
Smith’s rectal tube, 146, 162 
Spleen, the, 14 
Stable-management errors, pro- 
ductive of colic, 36 
Staggers, grass, 47 
stomach, 47 
Stimulants in 
207 
Stimulant treatment of intestinal 
impaction, 92 
Mr. Harding on, 118 
Stomach, anatomy of the, 9, 17 
dilatation of the, 52 
gorged, 47 
rupture of the, 73 
causes of, 73 
diagnosis of, 76 
prevention of, 79 
prognosis of, 78 
symptoms of, 74 
staggers, 47 
Stomach-tube, Knisely’s, 71 
Stoppage of the bowels, 80 


17—2 


superpurgation, 


260 THE COMMON COLICS OF THE HORSE 


Strangulated hernia in young 
animals, 226 
Subacute obstruction of double 
colon, 80 
cases of, 108, 122 
causes of, 82 
definition of, 80 
diagnosis of, 86 
prognosis of, 88 
symptoms of, 83 
treatment of, 89 
Subacute obstruction of pelvic 
flexure of colon, 123 
causes of, 124 
definition of, 123 
diagnosis of, 131 
prognosis of, 133 
symptoms of, 129 
treatment of, 134 
Subacute obstruction of single 
colon, 137 
causes of, 137 
definition of, 137 
diagnosis of, 142 
prognosis of, 143 
symptoms of, 139 
treatment of, 143 
Subacute obstruction of small in- 
testines, 147 
Superpurgation, 212 
causes of, 213 
chloral hydrate in, 216 
definition of, 212 
diagnosis of, 215 
morphia in, 216 
opium in, 217 
prognosis of, 216 
stimulants in, 217 
treatment of, 216 
Surgical regions of abdomen 
(Smith), 6 
Surgical treatment of intestinal 
obstructions, 173 
Sutures, Lembert’s, 180 
Suturing incision of bowel, 179 
Symptoms of enteritis, 205 
of gastric impaction, 49 
tympany, 56 
of intestinal tympany, I90 
of ruptured stomach, 74 


Symptoms of subacute obstruction 
of double colon, 83 
of single colon, 139 
of small intestines, 148 
of the pelvic flexure of the 
double colon, 129 


Tabular arrangement of abdominal 
organs, 15 

Temperamenta predisposing cause 
of colic, 34 

Temperature, the, 24 

The anatomy of the stomach, 8, 


17 
The colon, 13 
kidneys, 15 
large intestines, 12 
liver, 14 
pancreas, 14 
peritoneum, 8 
pulse, 24 
single colon, 14 
small intestines, II 
spleen, 14 
surgical regions of the abdo- 
men, 7 
temperature, 24 
weather as a_ predisposing 
cause of colic, 33 
Time occupied in passage of food 
through digestive canal of 
horse, 31 
compared with man, 32 
Time of day, influence of, on pro- 
duction of colic, 43 
Treatment of colic in foals, 221 
in yearlings and two-year- 
olds, 219 
of diarrhoea in young animals, 
225 
of enteritis, 209 
of gastric impaction, 50 
tympany, 65 
of impaction of the single 
colon, 143 
of intestinal tympany, 192 
of paralysis of the rectum, 143 
of subacute obstruction of the 
double colon, 89 
small intestines, 153 


INDEX 261 


Treatment of subacute obstruction 
of the pelvic flexure of the 
double colon, 134 

of superpurgation, 216 
sedative, of intestinal impac- 
tion, 89, 102 , 
stimulant, of intestinal im- 
paction, 92, 143, 154 
Turpentine inintestinal impaction, 
100 
Tympanites, 189 
Tympany, gastric, 52 
ammonia in, 66 
antizymotics in, 66 
case of, 69 
causes of, 54 
danger of sedatives in, 68 
definition of, 52 
diagnosis of, 59 
eructation in, 58 
gases present in, 65 
hydrate of iron in treatment 
of, 66 
prognosis of, 64 
symptoms of, 56 
treatment of, 65 
vomition in, 59, 65 
Tympany, intestinal, 189 
causes of, 189 


Tympany, definition of, 189 
diagnosis of, IgI 
enterocentesis in, 192 
prognosis of, 192 
puncturing bowel in, 192 
sedatives in, 199 
symptoms of, 190 
treatment of, 192 


Value of eserine in gastric tym- 
pany, 69 
Various exciting causes of colic, 35 
Vomiting as diagnostic of ruptured 
stomach, 77 
Vomition, hindrances to, 20, 29 
in gastric tympany, 59, 05 


Water as an exciting cause of 
colic, 37 

Water, best time to, 39 

Watering, methods of, 39 

Weather, the, as a predisposing 
cause of colic, 33 


Yearlings and two-year-olds, treat- 
ment of colic in, 219 
Young animals, intestinal impac- 
tion in, 225 
treatment of diarrhoea in, 222 


THE END 


Bailliére, Tindall and Cox. 8, Henrietta Street, Covent Garden 


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